Healthcare Provider Details

I. General information

NPI: 1114302353
Provider Name (Legal Business Name): POINT OF ROCKS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 LOCKHOUSE DR.
POINT OF ROCKS MD
21777-2104
US

IV. Provider business mailing address

14201 DALLAS PKWY
DALLAS TX
75254-2916
US

V. Phone/Fax

Practice location:
  • Phone: 301-874-2211
  • Fax: 301-874-2079
Mailing address:
  • Phone: 972-763-3859
  • Fax: 972-920-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 203-609-1168