Healthcare Provider Details

I. General information

NPI: 1881002343
Provider Name (Legal Business Name): INNOVATIVE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 LEWIS LN SUITE 301
HAVRE DE GRACE MD
21078-3750
US

IV. Provider business mailing address

253 LEWIS LN SUITE 301
HAVRE DE GRACE MD
21078-3750
US

V. Phone/Fax

Practice location:
  • Phone: 410-942-0620
  • Fax:
Mailing address:
  • Phone: 410-942-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberD0073023
License Number StateMD

VIII. Authorized Official

Name: HYON K SCHNEIDER
Title or Position: OWNER
Credential: MD
Phone: 410-942-0620