Healthcare Provider Details

I. General information

NPI: 1528307188
Provider Name (Legal Business Name): SGFC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DULANEY VALLEY ROAD SUITE 100
TOWSON MD
21204-0622
US

IV. Provider business mailing address

9600 BLACKWELL ROAD SUITE 500
ROCKVILLE MD
20850-3783
US

V. Phone/Fax

Practice location:
  • Phone: 410-512-8300
  • Fax: 855-334-8171
Mailing address:
  • Phone: 301-340-1188
  • Fax: 301-340-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KRISTIN RAKER
Title or Position: SVP FINANCE AND ACCOUNTING
Credential:
Phone: 301-545-1370