1750511879 NPI number — WHITMAN WALKER CLINIC, INC

Table of content: (NPI 1750511879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750511879 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:
ELIZABETH TAYLOR MEDICAL CENTER
Provider Other Organization Name Type Code:
5
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:
1750511879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 14TH 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:
20009-4308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-745-6149
Provider Business Mailing Address Fax Number:
202-483-7691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 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:
20009-4308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-745-6149
Provider Business Practice Location Address Fax Number:
202-483-7691
Provider Enumeration Date:
07/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KEITA
Authorized Official First Name:
NIA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR STAFF NURSE
Authorized Official Telephone Number:
202-745-6149

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  RN961755 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com