MEDICARE: RESTON SURGERY CENTER, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	OH690	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659335438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTON SURGERY CENTER, LP

Provider Business Mailing Address
First Line	:	1860 TOWN CENTER DR STE G100
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20190-5897
Country	:	US
Telephone Number	:	703-639-3100
Fax Number	:	703-639-3139

Provider Business Practice Location Address
First Line	:	1860 TOWN CENTER DR
Second Line	:	SUITE G100
City	:	RESTON
State	:	VA
Zip	:	20190-5896
Country	:	US
Telephone Number	:	703-639-3100
Fax Number	:	703-639-3139

Authorized Official
Title or Position	:	VP/CFO
Name	:	DAVID MCKNIGHT
Credential	:
Telephone Number	:	972-789-2816

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	06/09/2026

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Directions to “RESTON SURGERY CENTER, LP ” Practice Location

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