Provider Demographics
NPI:1073073458
Name:GERMANTOWN AMBULATORY SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:GERMANTOWN AMBULATORY SURGICAL CENTER LLC
Other - Org Name:SHAHLA FARSAII
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASGHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:FARSAII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-428-3040
Mailing Address - Street 1:20629 BOLAND FARM RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4017
Mailing Address - Country:US
Mailing Address - Phone:301-428-3040
Mailing Address - Fax:
Practice Address - Street 1:20629 BOLAND FARM RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4017
Practice Address - Country:US
Practice Address - Phone:301-428-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4215346000Medicaid