Healthcare Provider Details

I. General information

NPI: 1720912538
Provider Name (Legal Business Name): ASC DEVELOPMENT COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 SETON DR
CUMBERLAND MD
21502-1818
US

IV. Provider business mailing address

4960 SW 72ND AVE STE 405
MIAMI FL
33155-5506
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-2543
  • Fax: 301-777-2583
Mailing address:
  • Phone: 469-458-9222
  • 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: SHANEKA TINCH
Title or Position: RCM MANAGER
Credential:
Phone: 470-798-7293