Basic Information
| Provider Information | |||||||||
| NPI: | 1821453820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOREFRONT ASC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 YORK ST | ||||||||
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| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542204630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206639013 | ||||||||
| FaxNumber: | 9206841439 | ||||||||
| Practice Location | |||||||||
| Address1: | 8301 OLD COURTHOUSE RD | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221853804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034420300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2015 | ||||||||
| LastUpdateDate: | 12/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | KATZ | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | MD PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9606639013 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.