Provider Demographics
NPI:1285736207
Name:PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER
Entity type:Organization
Organization Name:PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-224-4448
Mailing Address - Street 1:139 OLD SOLOMONS ISLAND ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANNANPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-0902
Mailing Address - Country:US
Mailing Address - Phone:410-224-4448
Mailing Address - Fax:443-949-9539
Practice Address - Street 1:139 OLD SOLOMONS ISLAND ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:ANNANPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-0902
Practice Address - Country:US
Practice Address - Phone:410-224-4448
Practice Address - Fax:443-949-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1134261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
336913OtherFELRA
706667OtherAETNA HMO TRADITIONAL
79740000OtherFEDERAL EMPLOYEE PROGRAM
6949277OtherCIGNA
706667OtherAETNA
483463OtherNCPPO
5147492OtherAETNA
336913OtherMDIPA
336913OtherMAMSI LIFE & HEALTH
336913OtherALLIANCE
MD402820100Medicaid
336913OtherGEHA
ZZ22OtherPTAN
522197293OtherTRICARE
60853301OtherCAREFIRST BC BS
NH8OtherGHMSI
336913OtherMDIPA
79740000OtherFEDERAL EMPLOYEE PROGRAM
336913OtherMAMSI LIFE & HEALTH
X16533Medicare UPIN