Provider Demographics
NPI:1447258603
Name:SNOWDEN RIVER SURGERY CENTER LLC
Entity type:Organization
Organization Name:SNOWDEN RIVER SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GROCHMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-461-0960
Mailing Address - Street 1:6011 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6074
Mailing Address - Country:US
Mailing Address - Phone:410-461-0960
Mailing Address - Fax:410-461-0967
Practice Address - Street 1:6011 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6074
Practice Address - Country:US
Practice Address - Phone:410-461-0960
Practice Address - Fax:410-461-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1416261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD253605OtherKAISER PERMANENTE
MD408126900OtherMEDICAL ASSISTANCE
MD2139172OtherUNITED HEALTH CARE MAMSI
MDRW3OtherCARE FIRST BCBS XIC
MD3968840OtherAETNA MEDICARE
MD2139172OtherONE NET
MD2139172OtherOPTIMUM CHOICE
MD3968840OtherAETNA HMO
MDRW3OtherCARE FIRST BCBS FEDERAL
MD116594OtherJOHN HOPKINS HEALTH CARE
MD64628701OtherCARE FIRST BCBS
MD7374667OtherAETNA PPO
MDP00220115OtherRAILROAD MEDICARE
MD253605OtherKAISER PERMANENTE