Healthcare Provider Details

I. General information

NPI: 1730187337
Provider Name (Legal Business Name): MT AIRY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TWIN ARCH RD SUITE 3C
MOUNT AIRY MD
21771-4138
US

IV. Provider business mailing address

1001 TWIN ARCH RD SUITE 3C
MOUNT AIRY MD
21771-4138
US

V. Phone/Fax

Practice location:
  • Phone: 410-549-2100
  • Fax: 410-549-2807
Mailing address:
  • Phone: 410-549-2100
  • Fax: 410-549-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1089
License Number StateMD

VIII. Authorized Official

Name: KEVIN K KELBY
Title or Position: SR VICE PRESIDENT-FINANCE
Credential:
Phone: 410-848-3000