MEDICARE: PINEY ORCHARD 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

General Provider Information

NPI Number	:	1780618801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINEY ORCHARD SURGERY CENTER, LLC.

Provider Business Mailing Address
First Line	:	PO BOX 631688
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21263-1688
Country	:	US
Telephone Number	:	814-689-2066
Fax Number	:	814-689-2001

Provider Business Practice Location Address
First Line	:	1132 ANNAPOLIS RD
Second Line	:
City	:	ODENTON
State	:	MD
Zip	:	21113-1647
Country	:	US
Telephone Number	:	410-674-0020
Fax Number	:	410-674-6226

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. DOUGLAS ROBERT COLKITT
Credential	:	M.D.
Telephone Number	:	941-346-0858

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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