1407004534 NPI number — ASC DEVELOPMENT COMPANY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407004534 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:
1407004534
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:
410-290-9191
Provider Business Mailing Address Fax Number:
410-290-7330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7120 MINSTREL WAY
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-5248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-290-9191
Provider Business Practice Location Address Fax Number:
410-290-7330
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:
410-290-9191

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: 589 . This is a "BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 89379501 . This is a "BLUE CROSS REGIONAL PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00381350 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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