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Organization
PEMBROOKE SQUARE SURGERY CENTER, LLC
Active
Organization
PEMBROOKE SQUARE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA F CONLEY CPC-H (BUSINESS OFFICE MANAGER)
(301) 396-8492
Entity
Organization
Contact information
Practice address
11370 PEMBROOKE SQ, WALDORF, MD 20603-4842
(301) 396-8492
(301) 396-8498
Mailing address
11370 PEMBROOKE SQ, WALDORF, MD 20603-4842
(301) 396-8492
(301) 396-8498
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1407
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3771631
AETNA HMO
—
05
—
407056900
—
MD
01
—
64470501
BCBS OF MD
MD
01
—
7862630
AETNA PPO
—
01
—
RT6
BCBS NATIONAL CAP AREA
DC
Enumeration date
09/27/2005
Last updated
11/18/2009
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