SHADY GROVE SURGERY CENTER LLC NPI 1194222620

NPI Information

  • NPI: 1194222620
  • Provider Name: SHADY GROVE SURGERY CENTER LLC
  • Classification: Obstetrics & Gynecology - 207V00000X
  • Entity Type: Organization
  • CLIA Number: 21D2040539
  • Address: 2403 RESEARCH BLVD STE 200
    ROCKVILLE, MD
    ZIP 20850
  • Phone: (240) 912-4546

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NPI Details

SHADY GROVE SURGERY CENTER LLC is an obstetrics gynecology in Rockville, MD. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. SHADY GROVE SURGERY CENTER LLC NPI is 1194222620. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2403 RESEARCH BLVD STE 200
ROCKVILLE, MD
ZIP 20850-289
Phone: (240) 912-4546
Fax: (240) 912-4471

The provider's authorized official is Kathy Michelle Jones .
The authorized official title is Office Manager and has the following contact phone number (240) 912-4546.

The CLIA number assigned to this NPI record is 21D2040539 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/11/2018 and was last updated on 4/11/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & GynecologyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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