=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093786501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGERY CENTER OF EASTON LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2006
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 IDLEWILD AVE SUITE 110
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-3881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-820-4470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 IDLEWILD AVE SUITE 110
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-3824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-820-4470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. MELODY DAWN HARGROVE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 410-820-4470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | A1236
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------