Healthcare Provider Details

I. General information

NPI: 1295725711
Provider Name (Legal Business Name): SOUTHERN DELAWARE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18941 JOHN J WILLIAMS HWY
REHOBOTH BEACH DE
19971-4404
US

IV. Provider business mailing address

18941 JOHN J WILLIAMS HWY
REHOBOTH BEACH DE
19971-4404
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-6992
  • Fax: 302-644-6995
Mailing address:
  • Phone: 302-644-6992
  • Fax: 302-644-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberFSSC-012
License Number StateDE

VIII. Authorized Official

Name: MARTI POTTER
Title or Position: ADMINISTRATOR
Credential: RN,CNOR,MHCA
Phone: 302-644-6992