Provider Demographics
NPI:1861490120
Name:DELMARVA SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:DELMARVA SURGERY CENTER, LLC
Other - Org Name:DELMARVA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:410-543-4590
Mailing Address - Street 1:641 S SALISBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5429
Mailing Address - Country:US
Mailing Address - Phone:410-543-4590
Mailing Address - Fax:410-543-8215
Practice Address - Street 1:641 S SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5429
Practice Address - Country:US
Practice Address - Phone:410-543-4590
Practice Address - Fax:410-543-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1359261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21C0001359Medicare Oscar/Certification
MD143ZMedicare PIN