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General NPI Number Information
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NPI Number | 1528077658
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Entity Type | Organization
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Legal Business Name | PRINCE WILLIAM AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 8644 SUDLEY RD SUITE 201
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City | MANASSAS
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State | VA
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Zip | 20110-4417
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Country | US
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Telephone | 703-369-8525
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Fax | 571-229-1533
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Provider Business Mailing Address
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Address Line | 8644 SUDLEY RD SUITE 201
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City | MANASSAS
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State | VA
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Zip | 20110-4417
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Country | US
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Telephone | 703-369-8525
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Fax | 571-229-1533
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Authorized Official
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Title or Position | OFFICER / AUTHORIZED OFFICIAL
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Name | KRISTEN O'CONNOR
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Credential |
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Telephone | 615-376-7315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | OH695
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License Number State | VA
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