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Organization
SHADY GROVE AMBULATORY SURGERY CENTER,LLC
Active
Organization
SHADY GROVE AMBULATORY SURGERY CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD ALLEN FOOTER D.P.M. (MEDICAL DIRECTOR)
(301) 948-2995
Entity
Organization
Contact information
Practice address
16220 S FREDERICK AVE, SUITE 427, GAITHERSBURG, MD 20877-4039
(301) 948-2995
(301) 948-6056
Mailing address
16220 S FREDERICK AVE, SUITE 427, GAITHERSBURG, MD 20877-4039
(301) 948-2995
(301) 948-6056
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1135
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A1135
MARYLAND STATE LICENSE #
MD
Enumeration date
09/02/2006
Last updated
08/25/2009
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