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General NPI Number Information
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NPI Number | 1689749350
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Entity Type | Organization
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Legal Business Name | COLUMBIA UROLOGICAL SURGICAL CENTER, L.L.C.
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 11085 LITTLE PATUXENT PKWY SUITE 204
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City | COLUMBIA
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State | MD
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Zip | 21044-2983
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Country | US
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Telephone | 410-997-5422
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Fax | 410-997-4359
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Provider Business Mailing Address
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Address Line | 11085 LITTLE PATUXENT PKWY SUITE 207
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City | COLUMBIA
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State | MD
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Zip | 21044-2983
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Country | US
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Telephone | 410-997-5422
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Fax | 410-997-4359
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN JOSEPH KISHEL
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Credential | M.D.
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Telephone | 410-997-5422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QL0400X
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Taxonomy Name | Lithotripsy Clinic/Center
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License Number | A1142
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A1142
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License Number State | MD
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