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General NPI Number Information
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NPI Number | 1710032842
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Entity Type | Organization
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Legal Business Name | MSC AMBULATORY SURGICAL CENTER
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 77 THOMAS JOHNSON DR STE E
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City | FREDERICK
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State | MD
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Zip | 21702-4893
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Country | US
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Telephone | 301-695-8346
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Fax | 301-624-5837
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Provider Business Mailing Address
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Address Line | 77 THOMAS JOHNSON DR STE E
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City | FREDERICK
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State | MD
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Zip | 21702-4893
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Country | US
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Telephone | 301-695-8346
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Fax | 301-668-7819
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CORRIE POWELL
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Credential |
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Telephone | 301-695-8346
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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 | 21C0001422
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License Number State | MD
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