Provider Demographics
NPI:1003004482
Name:SUMMIT AMBULATORY SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:SUMMIT AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-779-6135
Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5421
Mailing Address - Country:US
Mailing Address - Phone:443-738-2872
Mailing Address - Fax:443-738-2713
Practice Address - Street 1:6535 N CHARLES ST STE 625
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5835
Practice Address - Country:US
Practice Address - Phone:410-825-5454
Practice Address - Fax:410-825-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD800906600Medicaid
MD208ZMedicare PIN
MD21C0001071Medicare UPIN