MEDICARE: FORBES AMBULATORY SURGERY CENTER, L.L.C.

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	A1474	MD

General Provider Information

NPI Number	:	1053336883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORBES AMBULATORY SURGERY CENTER, L.L.C.

Provider Business Mailing Address
First Line	:	7501 FORBES BLVD
Second Line	:	SUITE 103
City	:	LANHAM
State	:	MD
Zip	:	20706-2253
Country	:	US
Telephone Number	:	301-805-5340
Fax Number	:	301-805-5341

Provider Business Practice Location Address
First Line	:	7501 FORBES BLVD
Second Line	:	SUITE 103
City	:	SEABROOK
State	:	MD
Zip	:	20706-2253
Country	:	US
Telephone Number	:	301-805-5340
Fax Number	:	301-805-5341

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. KWASI DEBRA
Credential	:	M.D.
Telephone Number	:	301-552-9495

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/05/2009

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