Provider Demographics
NPI:1386885556
Name:THE ASC AT WAUGH CHAPEL
Entity type:Organization
Organization Name:THE ASC AT WAUGH CHAPEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-262-1171
Mailing Address - Street 1:4000 MITCHELLVILLE RD STE A400
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3137
Mailing Address - Country:US
Mailing Address - Phone:301-262-1171
Mailing Address - Fax:301-262-7483
Practice Address - Street 1:4000 MITCHELLVILLE RD STE A400
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3137
Practice Address - Country:US
Practice Address - Phone:301-262-1171
Practice Address - Fax:301-262-7483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical