Provider Demographics
NPI:1255194189
Name:INOVA OAKVILLE AMBULATORY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:INOVA OAKVILLE AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R & OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARASINH
Authorized Official - Middle Name:PHOUMMITHONE
Authorized Official - Last Name:MAYARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-395-6410
Mailing Address - Street 1:400 FANNON ST.
Mailing Address - Street 2:200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301
Mailing Address - Country:US
Mailing Address - Phone:703-672-2624
Mailing Address - Fax:703-672-2650
Practice Address - Street 1:400 FANNON ST STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301
Practice Address - Country:US
Practice Address - Phone:703-672-2635
Practice Address - Fax:703-672-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical