Provider Demographics
NPI:1831153527
Name:THE SURGICAL CENTER OF GREATER ANNAPOLIS, INC.
Entity type:Organization
Organization Name:THE SURGICAL CENTER OF GREATER ANNAPOLIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-757-5019
Mailing Address - Street 1:83 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2306
Mailing Address - Country:US
Mailing Address - Phone:410-757-5019
Mailing Address - Fax:410-757-5880
Practice Address - Street 1:83 CHURCH RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2306
Practice Address - Country:US
Practice Address - Phone:410-757-5019
Practice Address - Fax:410-757-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1029261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD189421800Medicaid
MD189421800Medicaid