Organization
CERTIFIED AMBULATORY SURGERY CENTER
Active
Other names
CASC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE G LEITHAUSE M.D. (PRESIDENT)
(301) 294-9400
Entity
Organization
Contact information
Practice address
9715 MEDICAL CENTER DR, 535, ROCKVILLE, MD 20850-3320
(301) 294-9400
(301) 294-0149
Mailing address
9715 MEDICAL CENTER DR, 535, ROCKVILLE, MD 20850-3320
(301) 294-9400
(301) 294-0149
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1225
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08820
AMERIGROUP
MD
01
—
0962486
AETNA
MD
05
—
1681001 00
—
MD
01
—
251543
MAMSI
MD
01
—
58426801
CF BC/BS MD
MD
01
—
ND9
CF BC/BS NCA
MD
Enumeration date
08/10/2005
Last updated
03/03/2011
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