Provider Demographics
NPI:1982871935
Name:NORTHERN VIRGINIA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR & 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 1:3620JOSEPH SIEWICK DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-766-6960
Mailing Address - Fax:703-766-6980
Practice Address - Street 1:3620 JOSEPH SIEWICK DR STE 202
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1758
Practice Address - Country:US
Practice Address - Phone:703-766-6960
Practice Address - Fax:703-766-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical