1578653721 NPI number — BUMED

Table of content: (NPI 1578653721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578653721 NPI number — BUMED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUMED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578653721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 E ST NW CODE # M3C3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20372-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-762-3017
Provider Business Mailing Address Fax Number:
202-762-3023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 E ST NW CODE # M3B6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20372-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-762-3017
Provider Business Practice Location Address Fax Number:
202-762-3023
Provider Enumeration Date:
10/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOULD
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PROGRAM MANAGER FOR SUBSTANCE ABUSE
Authorized Official Telephone Number:
202-762-3016

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LMSW 3927 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)