1770955304 NPI number — TMS NEUROHEALTH CENTERS, ASHBURN, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770955304 NPI number — TMS NEUROHEALTH CENTERS, ASHBURN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TMS NEUROHEALTH CENTERS, ASHBURN, 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:
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:
1770955304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8405 GREENSBORO DR STE 120
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
MC LEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22102-5106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-356-1568
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44355 PREMIER PLZ
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147-5049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-356-1568
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CEFALU
Authorized Official First Name:
KELLI
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL MANAGER
Authorized Official Telephone Number:
571-359-1171

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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