Organization
COUNTRYSIDE AMBULATORY SURG CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN GRISH (CHIEF FINANCIAL OFFICER)
(703) 858-6604
Entity
Organization
Contact information
Practice address
44045 RIVERSIDE PKWY, LEESBURG, VA 20176-5101
(703) 858-6000
Mailing address
4 PIDGEON HILL DR, STERLING, VA 20165-6101
(703) 737-7513
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OH 652
VA
Other
Enumeration date
07/23/2006
Last updated
08/22/2020
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