PHOENIX SURGICAL CARE LLC (NPI# 1518593797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518593797 |
| Entity Type | Organization |
| Organization Name | PHOENIX SURGICAL CARE LLC |
| Other Organization Name | PHOENIX SURGICAL CARE |
| Practice Address |
174 Thomas Johnson Dr Ste 100 Frederick MD 21702-4569 |
| Practice Telephone | 3016622000 |
| Practice Fax Number | 3016622500 |
| Mailing Telephone | 3016622000 |
| Mailing Fax Number | 3016622500 |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2020-09-22 |
| Authorized Official Name | VERONICA RUBY ENNS (CREDENTIALING EXECUTIVE) |
| Authorized Official Telephone | 5305667810 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | STATE OF MARYLAND (DEPARTMENT OF HEALTH) | D0073819 | 01 |
| Other Name | Type Code |
|---|---|
| Phoenix Surgical Care | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 197 Thomas Johnson Dr, Frederick, MD 217024314 | 3016622000 | |
| 77 Thomas Johnson Dr Ste K, Frederick, MD 217024893 | 3016622000 | 3016622500 |
| Street Address |
174 THOMAS JOHNSON DR STE 100 |
| City | FREDERICK |
| State | MD |
| Zip Code | 21702-4569 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750520888 | Jasmine Malcolm | Surgery | 174 Thomas Johnson Dr Ste 100, Frederick, MD 21702-4569 | 2009-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073129714 | Rita Akowuah | Nurse Practitioner | 1302 Baker Place East Apt 14, Frederick, MD 21702 | 2020-09-18 |
| 1912416272 | Morgan Nicely | Behavior Technician | 65 Thomas Johnson Drive Suite A, Frederick, MD 21702 | 2017-09-29 |
| 1154840494 | Centers for Advanced Orthopaedics, LLC | Orthopaedic Surgery | 184 Thomas Johnson Dr Ste 104, Frederick, MD 21702 | 2017-09-19 |
| 1831617471 | Hazel Elizabeth Gill | Physical Therapy Assistant | 2007 Butterfield Overlook, Frederick, MD 21702 | 2017-09-05 |
| 1831610161 | William Haynes | Nurse Practitioner | 103 Water Land Ct., Frederick, MD 21702 | 2017-06-27 |
| 1497299333 | Timothy Stimach | Pharmacist | 1430b W Patrick St, Frederick, MD 21702 | 2016-12-12 |
| 1184167405 | Maryland Nutrition and Diet Services, L.L.C. | Dietitian, Registered | 1301 W. 7th Street, No. 1607, Frederick, MD 21702 | 2016-11-18 |
| 1649649468 | Oluwakemi Olubunmi Osidele | Nurse Practitioner | 188 Thomas Johnson Dr Ste 102, Frederick, MD 21702 | 2015-09-22 |
| 1841678562 | Ventzislava Hristova | Spec/Tech, Pathology | 1050 Boyles St. Building 560 Room 12-39, National Cancer Institute - Frederick, Frederick, MD 21702 | 2015-05-14 |
| 1023404571 | Mychal Lynn Pilia | Advanced Practice Midwife | 7420 Hayward Road, Suite 104, Frederick, MD 21702 | 2015-04-11 |
| Find all providers in zip 21702 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750520888 | Jasmine Malcolm | Surgery | 174 Thomas Johnson Dr Ste 100, Frederick, MD 21702-4569 | 2009-02-12 |
| 1629271374 | Christine Kathryn Harris | Surgery | 7211 Bank Ct Ste 110, Frederick, MD 21703-8479 | 2007-06-08 |
| 1003877515 | Jesus Esquivel | Surgery | 7211 Bank Ct Ste 200, Frederick, MD 21703-8481 | 2006-04-01 |
| 1477522472 | Kelly Ann Shine | Surgery | 74 Thomas Johnson Dr, Frederick, MD 21702-4300 | 2006-03-14 |
| 1871571976 | Leonard Surgical Care Associates, LLC | Surgery | 501 W Seventh St, Suite D, Frederick, MD 21701-4507 | 2006-01-09 |
| 1326491291 | Usman Waheed, M.d., P.a. | Surgery | 110 Baughmans Ln, Frederick, MD 21702-4059 | 2016-07-15 |
| 1801235015 | Frederick Health Medical Group LLC | Surgery | 501 W 7th St, Frederick, MD 21701-4586 | 2013-06-20 |
| 1619314291 | Michael D. Winton | Surgery | 501 W 7th St, Frederick, MD 21701-4586 | 2013-05-23 |
| 1316290422 | Frederick Memorial Hospital Inc | Surgery | 7211 Bank Ct, Frederick, MD 21703-8483 | 2012-10-26 |
| 1770850547 | Frederick Health Medical Group LLC | Surgery | 7211 Bank Ct, Frederick, MD 21703-8483 | 2011-11-22 |
| Find all providers in FREDERICK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.