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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