Basic Information
| Provider Information | |||||||||
| NPI: | 1730147802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBINWOOD SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11110 MEDICAL CAMPUS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217426700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017144300 | ||||||||
| FaxNumber: | 3017144324 | ||||||||
| Practice Location | |||||||||
| Address1: | 11110 MEDICAL CAMPUS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217426700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017144300 | ||||||||
| FaxNumber: | 3017144324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 10/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | BUSHEY | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3017908880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | A1083 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 04811-1400 | 05 | MD | MEDICAID |