| Organization Name: | LEONARDTOWN SURGERY CENTER LLC |
| NPI Number: | 1174802045 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL T TRAVIS (CEO) |
| Mailing Address: | 40900 Merchants Ln Suite 200 Leonardtown |
| State: | MD US |
| Postal Code: | 206503795 |
| Phone Number: | 3016902203 |
| Fax Number: | |
| NPI Enumeration Date: | 08/10/2011 |
| NPI Last Update Date: | 02/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |