Organization
SECURITY AMBULATORY SURGI CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GALLOWAY ROTH JR. D.P.M. (PRESIDENT)
(410) 455-9660
Entity
Organization
Contact information
Practice address
2 E ROLLING CROSSROADS, SUITE 55, CATONSVILLE, MD 21228-6212
(410) 455-9660
(410) 455-9665
Mailing address
2 E ROLLING CROSSROADS, SUITE 55, CATONSVILLE, MD 21228-6212
(410) 455-9660
(410) 455-9665
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
A1357
MD
261QP1100X
Podiatric Clinic/Center
Primary
A1357
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024D
BLUECROSS BLUESHIELD MD
MD
01
—
3416026
AETNA
MD
01
—
RI5
CAREFIRST BLUECHOICE
MD
Enumeration date
07/04/2006
Last updated
08/17/2018
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