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1447258603

NPI Code Detail

MEDICARE: SNOWDEN RIVER SURGERY CENTER LLC

MEDICARE: SNOWDEN RIVER SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	A1416	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	3968840	OTHER	MD	AETNA MEDICARE
13	P00220115	OTHER	MD	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	253605	OTHER	MD	KAISER PERMANENTE
2	408126900	OTHER	MD	MEDICAL ASSISTANCE
3	2139172	OTHER	MD	UNITED HEALTH CARE MAMSI
4	RW3	OTHER	MD	CARE FIRST BCBS XIC
6	2139172	OTHER	MD	ONE NET
7	2139172	OTHER	MD	OPTIMUM CHOICE
8	3968840	OTHER	MD	AETNA HMO
9	RW3	OTHER	MD	CARE FIRST BCBS FEDERAL
10	116594	OTHER	MD	JOHN HOPKINS HEALTH CARE
11	64628701	OTHER	MD	CARE FIRST BCBS
12	7374667	OTHER	MD	AETNA PPO

General Provider Information

NPI Number	:	1447258603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNOWDEN RIVER SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	6011 UNIVERSITY BLVD
Second Line	:	SUITE 190
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6074
Country	:	US
Telephone Number	:	410-461-0960
Fax Number	:	410-461-0967

Provider Business Practice Location Address
First Line	:	6011 UNIVERSITY BLVD
Second Line	:	SUITE 190
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6074
Country	:	US
Telephone Number	:	410-461-0960
Fax Number	:	410-461-0967

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JAY C GROCHMAL
Credential	:	M.D.
Telephone Number	:	410-461-0960

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	01/06/2015

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Directions to “SNOWDEN RIVER SURGERY CENTER LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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