MEDICARE: ASC DEVELOPMENT COMPANY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN932	OTHER	MD	RAILROAD MEDICARE
4	P00081013	OTHER	MD	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	RM6	OTHER	MD	BLUE CROSS REGIONAL PLAN
3	L7	OTHER	MD	BLUE CROSS

General Provider Information

NPI Number	:	1023266145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASC DEVELOPMENT COMPANY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 931606
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-1606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CRAIN HWY S
Second Line	:	SUITE 301
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5577
Country	:	US
Telephone Number	:	410-787-8315
Fax Number	:	410-787-8316

Authorized Official
Title or Position	:	RCM MANAGER
Name	:	SHANEKA TINCH
Credential	:
Telephone Number	:	469-458-9222

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	12/08/2025

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Directions to “ASC DEVELOPMENT COMPANY, LLC ” Practice Location

Language	Start Address	Practice Location

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