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Organization
PRINCE WILLIAM AMBULATORY SURGERY CENTER, LLC
Active
Organization
PRINCE WILLIAM AMBULATORY SURGERY CENTER, LLC
Active
Other names
Prince William Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN O'CONNOR (OFFICER / AUTHORIZED OFFICIAL)
(615) 376-7315
Entity
Organization
Contact information
Practice address
8644 SUDLEY RD, SUITE 201, MANASSAS, VA 20110-4417
(703) 369-8525
(571) 229-1533
Mailing address
8644 SUDLEY RD, SUITE 201, MANASSAS, VA 20110-4417
(703) 369-8525
(571) 229-1533
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OH695
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010274656
—
VA
01
—
186080
ANTHEM
VA
01
—
186080
ANTHEM HEALTHKEEPERS
—
01
—
2142411
MDIPA/OPTIMUM CHOICE
—
01
—
2579620
UHC
—
01
—
9731258
CIGNA
—
Enumeration date
08/07/2006
Last updated
10/11/2024
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