Provider Demographics
NPI:1205897691
Name:REISTERSTOWN AMBULATORY SURGICAL CENTER
Entity type:Organization
Organization Name:REISTERSTOWN AMBULATORY SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-526-4402
Mailing Address - Street 1:113 WESTMINSTER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1026
Mailing Address - Country:US
Mailing Address - Phone:410-526-4401
Mailing Address - Fax:410-526-4414
Practice Address - Street 1:113 WESTMINSTER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1026
Practice Address - Country:US
Practice Address - Phone:410-526-4401
Practice Address - Fax:410-526-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1335261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
126ZMedicare ID - Type Unspecified