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General NPI Number Information
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NPI Number | 1174802045
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Entity Type | Organization
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Legal Business Name | LEONARDTOWN SURGERY CENTER LLC
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 40900 MERCHANTS LN SUITE 200
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City | LEONARDTOWN
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State | MD
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Zip | 20650-3795
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Country | US
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Telephone | 301-690-2203
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Fax |
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Provider Business Mailing Address
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Address Line | 40900 MERCHANTS LN UNIT 200
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City | LEONARDTOWN
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State | MD
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Zip | 20650-3796
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Country | US
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Telephone | 301-690-2203
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Fax |
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | JONATHAN BAILEY
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Credential |
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Telephone | 203-609-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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