NPIMap

Organization Active NPI

St. Mary'S Multispecialty Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Great Mills, MD
National Provider Identifier
1245249754
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
A1147 Issued in MD
Legal business name
ST. MARY'S MULTISPECIALTY SURGERY CENTER
Practice address
22325 Greenview Pkwy
Great Mills, MD 20634-3491
Phone
(301) 862-3338
Fax
(301) 862-3335
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Douglas H Hallgren, D.P.M.
Title
President
Phone
(301) 862-3338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X A1147 MD Primary

Addresses

Primary practice location

22325 Greenview Pkwy
Great Mills, MD 20634-3491

Mailing address

PO Box 1310
California, MD 20619-1310
Phone (301) 862-3338

Other identifiers 2

IdentifierTypeStateIssuer
58380901OtherMDBLUE CROSS/BLUE SHIELD
NK9OtherMDBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
St Mary'S Multi-Specialty Surgery Centre Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245249754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1310",
            "city": "CALIFORNIA",
            "state": "MD",
            "postal_code": "206191310",
            "telephone_number": "301-862-3338",
            "fax_number": "301-862-3335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22325 GREENVIEW PKWY",
            "city": "GREAT MILLS",
            "state": "MD",
            "postal_code": "206343491",
            "telephone_number": "301-862-3338",
            "fax_number": "301-862-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S MULTISPECIALTY SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HALLGREN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-862-3338",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "58380901",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NK9",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.