Healthcare Provider Details

I. General information

NPI: 1215000997
Provider Name (Legal Business Name): CHILDREN'S NATIONAL AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 KEY WEST AVE
ROCKVILLE MD
20850-3960
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-8764
  • Fax:
Mailing address:
  • Phone: 202-476-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA13221
License Number StateMD

VIII. Authorized Official

Name: PHILLICIA NELSON
Title or Position: REIMBURSEMENT OFFICER
Credential:
Phone: 301-572-6281