Healthcare Provider Details

I. General information

NPI: 1588071575
Provider Name (Legal Business Name): FOULK ROAD SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FOULK RD
WILMINGTON DE
19803-3155
US

IV. Provider business mailing address

900 FOULK RD
WILMINGTON DE
19803-3155
US

V. Phone/Fax

Practice location:
  • Phone: 302-777-4800
  • Fax: 302-777-2111
Mailing address:
  • Phone: 302-777-4800
  • Fax: 302-777-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateDE

VIII. Authorized Official

Name: STACEY TAYLOR
Title or Position: SR VP OF OPERATIONS
Credential: RN
Phone: 781-733-2234