MEDICARE: CHIPPENHAM AMBULATORY SURGERY CENTER, 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

General Provider Information

NPI Number	:	1093088999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIPPENHAM AMBULATORY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1115 BOULDERS PKWY STE 210
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-4067
Country	:	US
Telephone Number	:	804-672-4040
Fax Number	:	804-672-4030

Provider Business Practice Location Address
First Line	:	1115 BOULDERS PARKWAY
Second Line	:	SUITE 210
City	:	RICHMOND
State	:	VA
Zip	:	23225
Country	:	US
Telephone Number	:	804-672-4040
Fax Number	:	804-672-4030

Authorized Official
Title or Position	:	VP/CFO
Name	:	DAVID MCKNIGHT
Credential	:
Telephone Number	:	972-789-2816

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	06/09/2026

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