Mivc ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MIVC ASC, LLC

Practice address

9201 Cherry Lane
Laurel, MD 20707

Phone

(301) 497-1590

NPI assigned

Oct 20, 2016

Organization subpart

Yes

Parent organization

MINIMALLY INVASIVE VASCULAR CENTER OF MARYLANDAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffery Jarwri Dormu, DONPI 1366430316

Title

Ceo/Vascular Surgeon

Phone

(301) 497-1590

Specialties & licenses 1

Addresses

Part of

Minimally Invasive Vascular Center of Maryland LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Minimally Invasive Vascular Center of Maryland LLC

  • Vascular Surgery Physician
  • Laurel, MD
  • NPI 1457592685
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffery Jawni Dormu, D.O.

  • Vascular Surgery Physician
  • Laurel, MD
  • NPI 1366430316
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478044800000",
    "number": "1174074538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8730 CHERRY LN",
            "address_2": "SUITE 10",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207076212",
            "telephone_number": "301-497-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 CHERRY LANE",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "20707",
            "telephone_number": "301-497-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIVC ASC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINIMALLY INVASIVE VASCULAR CENTER OF MARYLAND",
        "enumeration_date": "2016-10-20",
        "last_updated": "2016-11-02",
        "status": "A",
        "authorized_official_last_name": "DORMU",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "JARWRI",
        "authorized_official_title_or_position": "CEO/VASCULAR SURGEON",
        "authorized_official_telephone_number": "301-497-1590",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen Denise Mitchell, PH.D.
• Denise Louise Mitchell, LCPC
• Evelyn Elizabeth Mitchell, LPC
• Sonya Mitchell, OT
• Soma Mitra, M.D.
• Abong Nasang Miyeh, MHNP
• MJM Anesthesia LLC
• MNR Industries LLC
• Mobile Staffing Solutions
• Modern Integrative Healthcare

• All providers in Laurel, MD
• Ambulatory Surgical Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.