Organization
ADVANTIA SURGICAL LLC
Active
Parent organization
ADVANTIA HOLDINGS OF MARYLAND LLC
Other names
Advantia Health Indian Creek ASC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVANTIA HOLDINGS OF MARYLAND LLC
Authorized official
DR. PETER GLASS MB. CHB. FFA (SA) (CHIEF MEDICAL OFFICER)
(240) 560-5092
Entity
Organization
Contact information
Practice address
12240 INDIAN CREEK CT STE 130, BELTSVILLE, MD 20705-1260
(240) 560-5092
Mailing address
12240 INDIAN CREEK CT STE 130, BELTSVILLE, MD 20705-1260
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
582166
THE JOINT COMMISSION CERTIFICATION
MD
01
—
A1572
MD STATE ASC LICENSE
MD
Enumeration date
02/03/2015
Last updated
06/28/2017
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