Provider Demographics
NPI:1912267592
Name:SURGCENTER AT NATIONAL HARBOR, LLC
Entity Type:Organization
Organization Name:SURGCENTER AT NATIONAL HARBOR, LLC
Other - Org Name:HARBORSIDE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-674-9041
Mailing Address - Street 1:125 POTOMAC PASS.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NATIONAL HARBOR
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1580
Mailing Address - Country:US
Mailing Address - Phone:703-674-9041
Mailing Address - Fax:
Practice Address - Street 1:125 POTOMAC PASSAGE
Practice Address - Street 2:SUITE 200
Practice Address - City:NATIONAL HARBOR
Practice Address - State:MD
Practice Address - Zip Code:20745-1580
Practice Address - Country:US
Practice Address - Phone:703-674-9041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical