1245222652 NPI number — DYNQUEST, INC.

Table of content: (NPI 1245222652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245222652 NPI number — DYNQUEST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNQUEST, INC.
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:
DYNQUEST MEDICAL AND DYNQUEST PHARMACY
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:
1245222652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8550 LEE HWY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-1519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-846-0002
Provider Business Mailing Address Fax Number:
703-846-0014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8550 LEE HWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-846-0002
Provider Business Practice Location Address Fax Number:
703-846-0014
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MERE
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
703-846-0002

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  B-000099607 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: B-000099607 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: B-000099607 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0201004356 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 9000 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 009107355 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 520075 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 768400200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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