Healthcare Provider Details

I. General information

NPI: 1912439829
Provider Name (Legal Business Name): DIRM SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD SUITE 117
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD SUITE 111
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-4600
  • Fax: 302-738-3508
Mailing address:
  • Phone: 302-738-4600
  • Fax: 302-738-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License NumberC10002852DE
License Number StateDE

VIII. Authorized Official

Name: MISS JEFFREY B RUSSELL
Title or Position: PRESIDENT
Credential: MD
Phone: 302-738-4600