PEMBROOKE SQUARE SURGERY CENTER, LLC (NPI# 1912993700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912993700 |
| Entity Type | Organization |
| Organization Name | PEMBROOKE SQUARE SURGERY CENTER, LLC |
| Practice Address |
11370 Pembrooke Sq Waldorf MD 20603-4842 |
| Practice Telephone | 3013968492 |
| Practice Fax Number | 3013968498 |
| Mailing Telephone | 3013968492 |
| Mailing Fax Number | 3013968498 |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2009-11-18 |
| Authorized Official Name | MRS. LISA F CONLEY (BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 3013968492 |
| Authorized Official Credential | CPC-H |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
A1407 | MD | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DC | BCBS NATIONAL CAP AREA | RT6 | 01 |
| AETNA HMO | 3771631 | 01 | |
| MD | 407056900 | 05 | |
| AETNA PPO | 7862630 | 01 | |
| MD | BCBS OF MD | 64470501 | 01 |
| Street Address |
11370 PEMBROOKE SQ |
| City | WALDORF |
| State | MD |
| Zip Code | 20603-4842 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508355470 | Surgical Associates Chartered | Surgery | 11370 Pembrooke Sq, Waldorf, MD 20603-4842 | 2018-05-07 |
| 1548796501 | Embarka Chaib | Nurse Practitioner | 11370 Pembrooke Sq, Waldorf, MD 20603-4842 | 2017-05-11 |
| 1275855637 | Meridian Anesthesia Services, LLC | Anesthesiology | 11370 Pembrooke Sq, Waldorf, MD 20603-4842 | 2010-02-25 |
| 1346350675 | Pembrooke Anesthesia Assoc., LLC | Anesthesiology | 11370 Pembrooke Sq, Waldorf, MD 20603-4842 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764214 | Kelly Weaver | Nurse Practitioner | 11315 Pembroke Square, 110, Waldorf, MD 20603 | 2020-09-09 |
| 1962937839 | Alexis Nicole Smith | Specialist/Technologist | 6115 Tapir Pl, Waldorf, MD 20603 | 2017-04-27 |
| 1235585472 | Msb Counseling Services, Inc | Counselor | 1282 Smallwood Drive W, Suite 460, Waldorf, MD 20603 | 2016-05-06 |
| 1619390325 | Tara Wood | Nurse Practitioner | 3070crain Highway, Waldorf, MD 20603 | 2014-01-31 |
| 1649603424 | Lauren Ashley White | Speech-Language Pathologist | 10810 Winchester Street Apt127, Waldorf, MD 20603 | 2013-08-15 |
| 1477810067 | Johnathan Vital | Clinical Neuropsychologist | 2413 Altenburg Ct, Waldorf, MD 20603 | 2012-04-19 |
| 1831480615 | Tara Marie Adams | Physical Therapist | 11340 Pembrooke Sq Ste 211, Waldorf, MD 20603 | 2011-04-27 |
| 1891007662 | Tanuja Katta | Pharmacist | 3385 Crain High Way, Rite Aid 11197, Waldorf, MD 20603 | 2010-07-09 |
| 1962725697 | Rhonda Bumpers-bland | Occupational Therapist | 2945 Fern Hill Place, Waldorf, MD 20603 | 2010-03-09 |
| 1265672901 | Shannon L Hamm | Counselor | 6126 Gray Wolf Court, Waldorf, MD 20603 | 2009-02-20 |
| Find all providers in zip 20603 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356831440 | Advanced Pain Management, LLC | Clinic/Center | 11637 Terrace Dr Ste 101, Waldorf, MD 20602-3707 | 2018-05-14 |
| 1790062636 | Bay Surgery Centers - Waldorf, LLC | Clinic/Center | 2960 Technology Pl Ste 103a, Waldorf, MD 20601-4968 | 2011-11-07 |
| 1447580394 | Advanced Pain Surgery Center LLC | Clinic/Center | 12070 Old Line Ctr Ste 205, Waldorf, MD 20602-2567 | 2009-12-28 |
| 1710112669 | Newbridge Surgery Center At Waldorf | Clinic/Center | 3581 Old Washington Road, Suite G, Waldorf, MD 20602 | 2009-05-21 |
| 1114168192 | Luxxery Corporation of Maryland | Clinic/Center | 3010 Crain Hwy, Suite 400, Waldorf, MD 20601-2801 | 2009-03-20 |
| 1588962831 | Asc Development Company, LLC | Clinic/Center | 3460 Old Washington Rd, Ste 300, Waldorf, MD 20602-3240 | 2011-03-10 |
| 1386949246 | Cambridge Womens Ambulatory Surgery Center, L.L.C. | Clinic/Center | 3500 Old Washington Rd, Suite 302, Waldorf, MD 20602-3224 | 2011-01-24 |
| 1518090406 | Hotchkiss Surgical Center, LLC | Clinic/Center | 12070 Old Line Ctr, Suite 110, Waldorf, MD 20602-2513 | 2007-03-13 |
| 1902984321 | Civista Partners Ambulatory Surgery Center | Clinic/Center | 3510 Old Washington Rd, Suite 200, Waldorf, MD 20602-3233 | 2006-11-02 |
| 1003889379 | The Waldorf Endoscopy Asc, LLC | Clinic/Center | 3510 Old Washington Rd, Waldorf, MD 20602-3233 | 2006-02-08 |
| Find all providers in WALDORF | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.