1871067207 NPI number — KAISER FOUNDATION HEALH PLAN OF THE MID-ATLANTIC STATES INC.

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 1871067207 NPI number — KAISER FOUNDATION HEALH PLAN OF THE MID-ATLANTIC STATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER FOUNDATION HEALH PLAN OF THE MID-ATLANTIC STATES 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:
KAISER PERMANENTE ALEXANDRIA PHARMACY
Provider Other Organization Name Type Code:
3
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:
1871067207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22370 DAVIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20164-5367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-466-4800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 POTOMAC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22305-3084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-721-6310
Provider Business Practice Location Address Fax Number:
703-721-6320
Provider Enumeration Date:
01/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BUTZ
Authorized Official First Name:
JOSEPTH
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
301-816-5867

Provider Taxonomy Codes

  • Taxonomy code: 3336M0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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