=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295923670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT AMBULATORY SURGICAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2007
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 CROSSROADS DR SUITE 220
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-5441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-581-1600
-----------------------------------------------------
Fax | 410-581-1603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 CROSSROADS DR SUITE 306
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-581-1600
-----------------------------------------------------
Fax | 410-581-1603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER/AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JONATHAN BAILEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-609-1168
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------