1942458062 NPI number — ASC DEVELOPMENT COMPANY, LLC

Table of content: (NPI 1942458062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942458062 NPI number — ASC DEVELOPMENT COMPANY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASC DEVELOPMENT COMPANY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942458062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11350 MCCORMICK RD STE 501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNT VALLEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21031-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-665-9696
Provider Business Mailing Address Fax Number:
240-420-5715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 PROFESIONAL COURT
Provider Second Line Business Practice Location Address:
SUITE P
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-665-9696
Provider Business Practice Location Address Fax Number:
240-420-5715
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BROUILLETTE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
REGIONAL MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-665-9696

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RE4 . This is a "BLUE CROSS REGIONAL PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 02TI . This is a "BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00081013 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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