Healthcare Provider Details

I. General information

NPI: 1710032842
Provider Name (Legal Business Name): MSC AMBULATORY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 THOMAS JOHNSON DR STE E
FREDERICK MD
21702-4893
US

IV. Provider business mailing address

77 THOMAS JOHNSON DR STE E
FREDERICK MD
21702-4893
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-8346
  • Fax: 301-624-5837
Mailing address:
  • Phone: 301-695-8346
  • Fax: 301-668-7819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number21C0001422
License Number StateMD

VIII. Authorized Official

Name: CORRIE POWELL
Title or Position: CREDENTIALING
Credential:
Phone: 301-695-8346