Provider Demographics
NPI:1407004534
Name:ASC DEVELOPMENT COMPANY, LLC
Entity Type:Organization
Organization Name:ASC DEVELOPMENT COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROUILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-290-9191
Mailing Address - Street 1:11350 MCCORMICK RD STE 501
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:410-290-9191
Mailing Address - Fax:410-290-7330
Practice Address - Street 1:7120 MINSTREL WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5248
Practice Address - Country:US
Practice Address - Phone:410-290-9191
Practice Address - Fax:410-290-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589OtherBLUE CROSS
MD89379501OtherBLUE CROSS REGIONAL PLAN
MDP00381350OtherRAILROAD MEDICARE
MD89379501OtherBLUE CROSS REGIONAL PLAN