NPIMap

Organization Active NPI

Hanover Parkway Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Greenbelt, MD
National Provider Identifier
1275710436
Registry record updated Feb 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
HANOVER PARKWAY SURGERY CENTER, LLC
Practice address
7300 Hanover Drive
Suite 204
Greenbelt, MD 20770
Phone
(301) 220-2333
Fax
(301) 220-2339
NPI assigned
Jan 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2009

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

Authorized official

Name
Dr. Haddis Tesfayohannes Hagos, M.D.
Title
President
Phone
(301) 220-2333

Specialties & licenses 1

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

Addresses

Primary practice location

7300 Hanover Drive
Suite 204
Greenbelt, MD 20770

Mailing address

7300 Hanover Drive
Suite 204
Greenbelt, MD 20770
Phone (301) 220-2333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090304000609 DC Part B Supplier - Ambulatory Surgical Center 7719043405 Practice locations: Greenbelt, MD

Ambulatory surgical center certification: CCN 21C0001492

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
HANOVER PARKWAY SURGERY CENTER
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
May 8, 2009
Last certification
May 21, 2018
Ownership / control type
Proprietary
Facility address
7300 Hanover Drive, Suite 204
Greenbelt, MD 20770

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D1084857Hanover Parkway Surgery Center7300 Hanover Drive #204, Greenbelt, MD 20770Certificate of waiverJun 4, 2028

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235347200000",
    "number": "1275710436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 HANOVER DRIVE",
            "address_2": "SUITE 204",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "20770",
            "telephone_number": "301-220-2333",
            "fax_number": "301-220-2339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 HANOVER DRIVE",
            "address_2": "SUITE 204",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "20770",
            "telephone_number": "301-220-2333",
            "fax_number": "301-220-2339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANOVER PARKWAY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-29",
        "last_updated": "2009-02-23",
        "status": "A",
        "authorized_official_last_name": "HAGOS",
        "authorized_official_first_name": "HADDIS",
        "authorized_official_middle_name": "TESFAYOHANNES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-220-2333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbelt, MD

Sources for this page

Verify at the official NPI Registry.