1427444108 NPI number — WASHINGTON MEDICAL CLINIC, LLC

Table of content: (NPI 1427444108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427444108 NPI number — WASHINGTON MEDICAL CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON MEDICAL CLINIC, 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:
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:
1427444108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12515 OLD GUNPOWDER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20705-1151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-908-2116
Provider Business Mailing Address Fax Number:
866-596-1084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12510 PROSPERITY DR
Provider Second Line Business Practice Location Address:
SUITE # 320
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20904-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-755-3380
Provider Business Practice Location Address Fax Number:
866-596-1084
Provider Enumeration Date:
04/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OBI
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
PRESIDENT /OWNER
Authorized Official Telephone Number:
301-908-2116

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R142632 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: F1213055 . This is a "AMERICAN ACADEMY NURSE PRACTITONERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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