The applications package for the Ambulatory Surgical Center must include all documents listed in the chart below. The Department reviews each application package and determines an applicant's eligibility for a license.
Specific instructions are provided within each form below.
Application Forms
Ambulatory Surgical Center Licensure Application Form [PDF]
Application Information Documents
DC Ownership and Disclosure Form [PDF]
Clean Hands Act of 1996 Certification Form [PDF]
Contact Phone:
(877) 672-2174
Contact Fax:
(202) 727-8471
Contact TTY:
711
Office Hours:
Monday to Friday 8:15 am to 4:45 pm
Service Location:
2201 Shannon Place SE
GIS Address:
2201 Shannon Place SE
City:
Washington
State:
DC
Zip:
20020