MEDICARE: FAIRFAX ENDOSCOPY 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	:	1831079714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRFAX ENDOSCOPY CENTER LLC

Provider Business Mailing Address
First Line	:	7120 MINSTREL WAY STE 100
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5274
Country	:	US
Telephone Number	:	410-290-6677
Fax Number	:	410-290-6676

Provider Business Practice Location Address
First Line	:	12011 ROUTE 50 STE 103
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-3323
Country	:	US
Telephone Number	:	410-290-6677
Fax Number	:	410-290-6676

Authorized Official
Title or Position	:	CEO
Name	:	ZACHARY JONES
Credential	:
Telephone Number	:	410-290-6677

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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Directions to “FAIRFAX ENDOSCOPY CENTER LLC ” Practice Location

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