Provider Demographics
NPI:1104460773
Name:THE SURGERY CLINICS LLC
Entity type:Organization
Organization Name:THE SURGERY CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAISHREE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-251-0070
Mailing Address - Street 1:15001 SHADY GROVE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6354
Mailing Address - Country:US
Mailing Address - Phone:301-251-0070
Mailing Address - Fax:301-251-0071
Practice Address - Street 1:14300 GALLANT FOX LN STE 110
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4031
Practice Address - Country:US
Practice Address - Phone:301-262-6797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty