1659496867 NPI number — WHITMAN-WALKER CLINIC, INC.

Table of content: (NPI 1659496867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659496867 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:
1659496867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 14TH STREET, 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:
20009-4308
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:
2301 MARTIN LUTHER KING JUNIOR AVENUE, SE
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:
20020-5813
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:
202-678-8099
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAGER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
DIRECTOR OF QUALITY IMPROVEMENT
Authorized Official Telephone Number:
202-797-3590

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)

  • Identifier: 038947600 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19666 . This is a "CHARTERED HEALTH PLAN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 022382100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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