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General NPI Number Information
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NPI Number | 1518090406
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Entity Type | Organization
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Legal Business Name | HOTCHKISS SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 12070 OLD LINE CTR SUITE 110
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City | WALDORF
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State | MD
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Zip | 20602-2513
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Country | US
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Telephone | 301-843-9581
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Fax |
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Provider Business Mailing Address
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Address Line | 12070 OLD LINE CTR SUITE 110
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City | WALDORF
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State | MD
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Zip | 20602-2513
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Country | US
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Telephone | 301-843-9581
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LARRY STEPHAN HOTCHKISS
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Credential | D.P.M.
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Telephone | 301-843-9581
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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 | A1420
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License Number State | MD
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