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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