=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104639509
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NSPC SURGERY CENTER OF FREDERICK, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2025
-----------------------------------------------------
Last Update Date | 01/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 THOMAS JOHNSON DR STE C
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21702-4895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-620-0012
-----------------------------------------------------
Fax | 301-620-9687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5280 CORPORATE DR STE C250
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21703-8508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER
-----------------------------------------------------
Name | YESHVANT NAVALGUND
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 855-836-7246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------