=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831153527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SURGICAL CENTER OF GREATER ANNAPOLIS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2006
-----------------------------------------------------
Last Update Date | 08/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 83 CHURCH RD
-----------------------------------------------------
City | ARNOLD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21012-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-757-5019
-----------------------------------------------------
Fax | 410-757-5880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 83 CHURCH RD
-----------------------------------------------------
City | ARNOLD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21012-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-757-5019
-----------------------------------------------------
Fax | 410-757-5880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE COORDINATOR
-----------------------------------------------------
Name | MRS. DEBBIE L. JORDAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-757-5019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | A1029
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------