Healthcare Provider Details

I. General information

NPI: 1386820694
Provider Name (Legal Business Name): URO-CENTER AMBULATORY SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11161 NEW HAMPSHIRE AVE SUITE 400
SILVER SPRING MD
20904-2606
US

IV. Provider business mailing address

11161 NEW HAMPSHIRE AVE SUITE 400
SILVER SPRING MD
20904-2606
US

V. Phone/Fax

Practice location:
  • Phone: 301-592-1225
  • Fax: 301-592-1229
Mailing address:
  • Phone: 301-592-1225
  • Fax: 301-592-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberD0017548
License Number StateMD

VIII. Authorized Official

Name: DR. ROBERT F BLYTHE
Title or Position: OWNER
Credential: M.D.
Phone: 301-592-1225