MEDICARE: MT AIRY SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	A1089	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730187337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT AIRY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1001 TWIN ARCH RD
Second Line	:	SUITE 3C
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-4138
Country	:	US
Telephone Number	:	410-549-2100
Fax Number	:	410-549-2807

Provider Business Practice Location Address
First Line	:	1001 TWIN ARCH RD
Second Line	:	SUITE 3C
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-4138
Country	:	US
Telephone Number	:	410-549-2100
Fax Number	:	410-549-2807

Authorized Official
Title or Position	:	SR VICE PRESIDENT-FINANCE
Name	:	KEVIN K KELBY
Credential	:
Telephone Number	:	410-848-3000

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/27/2009

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