=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952669798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUTTON SURGICAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2012
-----------------------------------------------------
Last Update Date | 04/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 LUBRANO DR L 101
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-7564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-758-5270
-----------------------------------------------------
Fax | 410-897-0342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 129 LUBRANO DR L 101
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-7564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-758-5270
-----------------------------------------------------
Fax | 410-897-0342
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MR. HUGH DAWKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-822-6175
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------