Provider Demographics
NPI:1023266145
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:MD
Authorized Official - Phone:410-787-8315
Mailing Address - Street 1:PO BOX 931606
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE 301
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-787-8315
Practice Address - Fax:410-787-8316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCN932OtherRAILROAD MEDICARE
MDRM6OtherBLUE CROSS REGIONAL PLAN
MDL7OtherBLUE CROSS
MDP00081013OtherRAILROAD MEDICARE
MDL7OtherBLUE CROSS