NPIMap

Organization Active NPI

Lakeforest Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • District Heights, MD
National Provider Identifier
1326202086
Registry record updated Jul 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
A1136 Issued in MD
Legal business name
LAKEFOREST AMBULATORY SURGERY CENTER
Practice address
6400 Marlboro Pike
District Heights, MD 20747-2841
Phone
(301) 736-6900
Fax
(301) 736-7180
NPI assigned
Jul 11, 2008
Last updated
Jul 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael Lawrence Michetti, DPMNPI 1245220789
Title
Medical Director and Owner
Phone
(301) 948-3668

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X A1136 MD Primary

Addresses

Primary practice location

6400 Marlboro Pike
District Heights, MD 20747-2841

Mailing address

702 Russell Ave
Suite 103
Gaithersburg, MD 20877-2606
Phone (301) 948-3668

Other names 1

  • District Heights Ambulatory Surgery Center Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215734400000",
    "number": "1326202086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 RUSSELL AVE",
            "address_2": "SUITE 103",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772606",
            "telephone_number": "301-948-3668",
            "fax_number": "301-926-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 MARLBORO PIKE",
            "city": "DISTRICT HEIGHTS",
            "state": "MD",
            "postal_code": "207472841",
            "telephone_number": "301-736-6900",
            "fax_number": "301-736-7180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEFOREST AMBULATORY SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-11",
        "last_updated": "2008-07-11",
        "status": "A",
        "authorized_official_last_name": "MICHETTI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR AND OWNER",
        "authorized_official_telephone_number": "301-948-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "District Heights Ambulatory Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in District Heights, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.