Provider Demographics
NPI:1528307188
Name:SGFC SURGERY CENTER, LLC
Entity type:Organization
Organization Name:SGFC SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP FINANCE AND ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-545-1370
Mailing Address - Street 1:9600 BLACKWELL ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3783
Mailing Address - Country:US
Mailing Address - Phone:301-340-1188
Mailing Address - Fax:301-340-1612
Practice Address - Street 1:901 DULANEY VALLEY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-0622
Practice Address - Country:US
Practice Address - Phone:410-512-8300
Practice Address - Fax:855-334-8171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHADY GROVE FERTILITY RSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-01
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical