Healthcare Provider Details

I. General information

NPI: 1891148219
Provider Name (Legal Business Name): SUMMIT AMBULATORY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 BUCKINGHAM BLVD SUITE 100
HANOVER MD
21076-3181
US

IV. Provider business mailing address

14201 DALLAS PKWY STE 306
DALLAS TX
75254-2916
US

V. Phone/Fax

Practice location:
  • Phone: 443-738-2872
  • Fax:
Mailing address:
  • Phone: 469-872-4706
  • 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: JONATHAN BEASLEY
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 203-609-1168