Healthcare Provider Details

I. General information

NPI: 1407004534
Provider Name (Legal Business Name): ASC DEVELOPMENT COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 MINSTREL WAY SUITE 106
COLUMBIA MD
21045-5248
US

IV. Provider business mailing address

PO BOX 931606
ATLANTA GA
31193-1606
US

V. Phone/Fax

Practice location:
  • Phone: 410-290-9191
  • Fax: 410-290-7330
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD J BROUILLETTE
Title or Position: REGIONAL MEDICAL DIRECTOR
Credential: DO
Phone: 410-290-9191