Basic Information
| Provider Information | |||||||||
| NPI: | 1023199601 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANNE ARUNDEL UROLOGICAL SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 RIDGELY AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214011045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102668049 | ||||||||
| FaxNumber: | 4102668054 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 RIDGELY AVE | ||||||||
| Address2: | SUITE 223 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214011001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102668049 | ||||||||
| FaxNumber: | 4102668054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCIRO | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4102668049 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QL0400X | A1235 | MD | N | Ambulatory Health Care Facilities | Clinic/Center | Lithotripsy | 261QA1903X | A1235 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.