Provider Demographics
NPI:1912090432
Name:MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE, LLC
Entity type:Organization
Organization Name:MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAWLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-416-2141
Mailing Address - Street 1:1133 21ST ST NW
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3390
Mailing Address - Country:US
Mailing Address - Phone:202-223-9040
Mailing Address - Fax:202-223-9047
Practice Address - Street 1:1133 21ST ST NW
Practice Address - Street 2:SUITE 1000
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3390
Practice Address - Country:US
Practice Address - Phone:202-223-9040
Practice Address - Fax:202-223-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHFD06 0105261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC300825Medicare ID - Type Unspecified