FAIRFAX COLON & RECTAL SURGERY CENTER, LLC
NPI 1306957485
Clinic/Center - Ambulatory Surgical in Fairfax, VA

Q: What is Fairfax Colon & Rectal Surgery Center, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Active since August 31, 2006CLIA Certified · 5 labs

2710 PROSPERITY AVE STE 200, FAIRFAX, VA 22031(703) 280-2841(703) 650-2322 Get Directions Write a Review

NPPES record last updated: December 4, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Fairfax Colon & Rectal Surgery Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAIRFAX COLON & RECTAL SURGERY CENTER, LLC (NPI 1306957485) is a healthcare organization registered as an ambulatory surgical in Fairfax, Virginia and active in the NPI registry since August 2006. The organization holds 5 active CLIA laboratory certificates and lists Michael Delac, Administrator, as its authorized official.

NPPES Registry Identity

NPI1306957485

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NameFAIRFAX COLON & RECTAL SURGERY CENTER, LLC

Location Address2710 PROSPERITY AVE STE 200Fairfax, VA 22031

Mailing Address2710 Prosperity Ave Ste 200Fairfax, VA 22031 · (703) 280-2841 · Fax (703) 650-2322

Phone(703) 280-2841

Fax(703) 650-2322

Organization SubpartYesParent: Fairfax Colon & Rectal Surgery, Pc

Authorized OfficialMichael DelacAdministrator · (703) 650-2333

Enumeration DateAugust 31, 2006

Last NPPES UpdateDecember 4, 2013

✔ NPI 1306957485 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

Also ListedSpecialistTaxonomy 174400000X

Also ListedColon & Rectal SurgeryTaxonomy 208C00000X

2710 PROSPERITY AVE STE 200, Fairfax, VA 22031

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 6

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D1061146

Fairfax Colon & Rectal Surgical Center · Fairfax, VA

Active · expires Nov 8, 2026

CLIA Number49D1061146

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateNovember 9, 2024

Certificate Expiration DateNovember 8, 2026

Laboratory DirectorRenee M. Flynn

Laboratory Phone(703) 280-2841

Laboratory LocationFairfax Colon & Rectal Surgical Center2710 Prosperity Avenue, Fairfax, VA 22031

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 49D2164279

Fairfax Colon & Rectal Surgery, PC · Gainesville, VA

Active · expires Apr 1, 2027

CLIA Number49D2164279

Laboratory TypePhysician Office

Certificate Effective DateApril 2, 2025

Certificate Expiration DateApril 1, 2027

Laboratory DirectorJohn D. Tillou

Laboratory Phone(703) 280-2841

Laboratory LocationFairfax Colon & Rectal Surgery, PC7051 Heathcote Village Way, Suite 135, Gainesville, VA 20155

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 49D2018883

Fairfax Colon & Rectal Surgery · Fairfax, VA

Active · expires Jan 17, 2027

CLIA Number49D2018883

Laboratory TypePhysician Office

Certificate Effective DateJanuary 18, 2025

Certificate Expiration DateJanuary 17, 2027

Laboratory DirectorKimberly A. Matzie

Laboratory Phone(703) 280-2841

Laboratory LocationFairfax Colon & Rectal Surgery3580 Joseph Siewick Drive - Suite 302, Fairfax, VA 22033

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 49D2101467

Fairfax Colon And Rectal Surgery, PC · Lansdowne, VA

Active · expires Sep 1, 2027

CLIA Number49D2101467

Laboratory TypePhysician Office

Certificate Effective DateSeptember 2, 2025

Certificate Expiration DateSeptember 1, 2027

Laboratory DirectorKatherine W. Khalifeh

Laboratory Phone(703) 280-2841

Laboratory LocationFairfax Colon And Rectal Surgery, PC44055 Riverside Parkway - Suite 108B, Lansdowne, VA 20176

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 49D2049381

Fairfax Colon And Rectal Surgery, PC · Alexandria, VA

Active · expires Nov 4, 2026

CLIA Number49D2049381

Laboratory TypePhysician Office

Certificate Effective DateNovember 5, 2024

Certificate Expiration DateNovember 4, 2026

Laboratory DirectorDonald B. Colvin

Laboratory Phone(703) 280-2841

Laboratory LocationFairfax Colon And Rectal Surgery, PC1806 N Beauegard Street - Suite 1110, Alexandria, VA 22311

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 49D0949345

Fairfax Colon Rectal Surgery PC · Fairfax, VA

Expired · Jul 30, 2026

CLIA Number49D0949345

Laboratory TypePhysician Office

Certificate Effective DateJuly 31, 2024

Certificate Expiration DateJuly 30, 2026

Laboratory DirectorDonald B. Colvin

Laboratory Phone(703) 280-2841

Laboratory LocationFairfax Colon Rectal Surgery PC2710 Prosperity Avenue - Suite 200, Fairfax, VA 22031

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

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Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALEXANDRA NICOLE MINUTILLO

Physician Assistant (Medical)