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Organization

LAKE RIDGE AMBULATORY SURGERY CENTER, LLC

Active
Other names
Lake Ridge Surgery Center
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JANET M SMITH RN (ADMINISTRATOR)
(703) 357-9568
Entity
Organization

Contact information

Practice address
12825 MINNIEVILLE ROAD, SUITE 204, WOODBRIDGE, VA 22192
(703) 357-9568
(703) 357-9575
Mailing address
12825 MINNIEVILLE ROAD, SUITE 204, WOODBRIDGE, VA 22192
(703) 357-9568
(703) 357-9575

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary

Other

Enumeration date
08/09/2012
Last updated
12/27/2013
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