| Organization Name: | FAMILY FOOTCARE AMBULATORY SURGERY CENTER, LLC |
| NPI Number: | 1306063177 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MIKEL DANIELS (OWNER) |
| Mailing Address: | 1123 Merritt Blvd Dundalk |
| State: | MD US |
| Postal Code: | 212221438 |
| Phone Number: | 4103634343 |
| Fax Number: | 4103566373 |
| NPI Enumeration Date: | 04/20/2007 |
| NPI Last Update Date: | 11/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | M00338 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |