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

General Provider Information

NPI Number	:	1306134838
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	:	8824 CUNNINGHAM DR
Second Line	:	SUITE D
City	:	BERWYN HEIGHTS
State	:	MD
Zip	:	20740-2338
Country	:	US
Telephone Number	:	240-965-0800
Fax Number	:	240-290-0037

Authorized Official
Title or Position	:	REGIONAL MEDICAL DIRECTOR
Name	:	RICHARD J BROUILLETTE
Credential	:	DO
Telephone Number	:	410-787-8315

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	06/02/2025

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Directions to “ASC DEVELOPMENT COMPANY LLC ” Practice Location

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