Basic Information
| Provider Information | |||||||||
| NPI: | 1841254695 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBIA FOOT AND ANKLE AMBULATORY SURGICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6100 DAYLONG LN | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210291626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435358770 | ||||||||
| FaxNumber: | 4435358775 | ||||||||
| Practice Location | |||||||||
| Address1: | 6100 DAYLONG LN | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210291626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435358770 | ||||||||
| FaxNumber: | 4435358775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TAUBMAN | ||||||||
| AuthorizedOfficialFirstName: | ROSS | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4435358770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.