1053363853 NPI number — RESTON HOSPITAL CENTER LLC

Table of content: (NPI 1053363853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053363853 NPI number — RESTON HOSPITAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTON HOSPITAL CENTER LLC
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:
RESTON HOSPITAL CENTER
Provider Other Organization Name Type Code:
3
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:
1053363853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 TOWN CENTER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20190-3219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-689-9000
Provider Business Mailing Address Fax Number:
703-689-9179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 TOWN CENTER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-689-9000
Provider Business Practice Location Address Fax Number:
703-689-9179
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EISEL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
703-689-9000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0888526 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166413900 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 435971 . This is a "GEHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000872946X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3295 . This is a "NYLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01583522 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 033172100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 063001200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100742 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 435971 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6560790 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 719 . This is a "WELLPOINT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 913644400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004901070 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10398A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 226610 . This is a "WELLPOINT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 431944200 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 516336 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".




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