Provider Demographics
NPI:1225128424
Name:ROCKVILLE AMBULATORY SURGERY, LP
Entity Type:Organization
Organization Name:ROCKVILLE AMBULATORY SURGERY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADAEZE
Authorized Official - Middle Name:I
Authorized Official - Last Name:OBIOHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-770-3334
Mailing Address - Street 1:11400 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3004
Mailing Address - Country:US
Mailing Address - Phone:301-770-3334
Mailing Address - Fax:301-770-3336
Practice Address - Street 1:11400 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 108
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3004
Practice Address - Country:US
Practice Address - Phone:301-770-3334
Practice Address - Fax:301-770-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1254261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD395502800Medicaid
MDA1254OtherLICENSE
MD314041Medicare ID - Type Unspecified