1992805022 NPI number — GOVERNMENT OF THE DISTRICT OF COLUMBIA OFFICE OF TAX AND REVENUE

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 1992805022 NPI number — GOVERNMENT OF THE DISTRICT OF COLUMBIA OFFICE OF TAX AND REVENUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOVERNMENT OF THE DISTRICT OF COLUMBIA OFFICE OF TAX AND REVENUE
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:
6
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:
1992805022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 717767
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19171-7767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-532-2198
Provider Business Mailing Address Fax Number:
614-987-2004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 14TH ST NW
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20009-4473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-673-3320
Provider Business Practice Location Address Fax Number:
202-462-0807
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEATON
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
RONALD
Authorized Official Title or Position:
EMS ADMINISTRATOR
Authorized Official Telephone Number:
202-727-5225

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D09728 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 402722100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0061387 . This is a "AETNA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 080046100 . This is a "FREDERAL BLACK LUNG PROGR" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 117947 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 14225 . This is a "SENIOR PARTNERS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 92423 . This is a "AMERIGROUP" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 140861FY . This is a "PREFERRED CARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: DC0089 . This is a "QUALMED" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: WORKERS COMPENSATION . This is a "DEPT OF LABOR" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 801187 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 030329900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590009227 . This is a "RAIL ROAD MCARE UNITED HC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 100690 . This is a "CHARTERED HEALTH PLAN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: B920-0001 . This is a "FEDERAL BC CARE FIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: DC0089 . This is a "PHS HEALTH PLAN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 145098 . This is a "UNISON DPA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: DC0089 . This is a "HEALTH NET" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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