1184616617 NPI number — WHITMAN-WALKER CLINIC, INC

Table of content: (NPI 1184616617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184616617 NPI number — WHITMAN-WALKER CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITMAN-WALKER CLINIC, 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:
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:
1184616617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1377 R ST NW
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:
20009-6293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-745-7000
Provider Business Mailing Address Fax Number:
202-797-3504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 14TH ST NW
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:
20005-3706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-745-7000
Provider Business Practice Location Address Fax Number:
202-797-3504
Provider Enumeration Date:
08/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
FELICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
202-797-4428

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X , with the licence number: MD33659 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 034298100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 038798600 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 038947600 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022385400 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".