Provider Demographics
NPI:1326097981
Name:FREDERICKSBURG AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:FREDERICKSBURG AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1414
Mailing Address - Street 1:1201 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4490
Mailing Address - Country:US
Mailing Address - Phone:540-741-7000
Mailing Address - Fax:540-899-6893
Practice Address - Street 1:1201 SAM PERRY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4490
Practice Address - Country:US
Practice Address - Phone:540-741-7000
Practice Address - Fax:540-899-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH656261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010055156Medicaid
VA442405OtherANTHEM BCBS
VA0700914OtherCIGNA
VA=========OtherUNITED
VA0700914OtherCIGNA