=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487695284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARFORD COUNTY AMBULATORY SURGERY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2006
-----------------------------------------------------
Last Update Date | 05/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1952A PULASKI HWY
-----------------------------------------------------
City | EDGEWOOD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21040-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-538-7000
-----------------------------------------------------
Fax | 410-679-7825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9601 PULASKI PARK DR STE 417
-----------------------------------------------------
City | MIDDLE RIVER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21220-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-933-5678
-----------------------------------------------------
Fax | 410-933-1823
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE ADMINISTRATOR
-----------------------------------------------------
Name | KIM MERRILL
-----------------------------------------------------
Credential | RN BSN
-----------------------------------------------------
Telephone | 410-538-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------