Provider Demographics
NPI:1891022000
Name:AMBULATORY UROLOGY SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:AMBULATORY UROLOGY SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:FOLMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-724-0132
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:12234 WILLIAMS ROAD
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-0419
Mailing Address - Country:US
Mailing Address - Phone:301-724-0132
Mailing Address - Fax:301-759-5874
Practice Address - Street 1:12234 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-724-0132
Practice Address - Fax:301-759-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty