Provider Demographics
NPI:1053560896
Name:ASC DEVELOPMENT COMPANY, LLC
Entity type:Organization
Organization Name:ASC DEVELOPMENT COMPANY, LLC
Other - Org Name:<UNAVAIL>
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:443-643-3000
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:443-643-3000
Mailing Address - Fax:
Practice Address - Street 1:510 UPPER CHESAPEAKE DR
Practice Address - Street 2:SUITE 415
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4328
Practice Address - Country:US
Practice Address - Phone:443-643-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical