Provider Demographics
NPI:1871711689
Name:CONGRESSIONAL AMBULATORY SURGERY CENTER, L.L.C.
Entity type:Organization
Organization Name:CONGRESSIONAL AMBULATORY SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-294-8525
Mailing Address - Street 1:14995 SHADY GROVE RD STE 410
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8726
Mailing Address - Country:US
Mailing Address - Phone:301-294-8525
Mailing Address - Fax:301-294-5919
Practice Address - Street 1:14995 SHADY GROVE RD STE 410
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8726
Practice Address - Country:US
Practice Address - Phone:301-294-8525
Practice Address - Fax:301-294-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1430261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411674700Medicaid