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1320 Marion Barry Ave Se Washington DC 20020-6912 | |
| (202) 610-1886 | |
| (202) 610-1887 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1320 Marion Barry Ave Se, Washington, District Of Columbia |
| Authorized Official Name and Position | Zack Ragsdale (DIRECTOR OF CONTRACTING & CRED) |
| Authorized Official Contact | 5124545911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5001 Spring Valley Road Suite 600 East Dallas TX 75244-3946 Ph: (214) 365-6100 | 1320 Marion Barry Ave Se Washington DC 20020-6912 Ph: (202) 610-1886 |
| NPI Number | 1609586684 |
|---|---|
| Provider Enumeration Date | 11/30/2022 |
| Last Update Date | 07/23/2024 |
| Certification Date | 06/10/2024 |
| Medicare PECOS PAC ID | 8921460452 |
|---|---|
| Medicare Enrollment ID | O20230816001467 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609586684 | NPI | - | NPPES |
| Provider Name | Nnemdi Kamanu Elias |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538369830 PECOS PAC ID: 5395046122 Enrollment ID: I20151221000000 |
| Provider Name | Mercy Eseme-efobi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891191946 PECOS PAC ID: 8921360355 Enrollment ID: I20180326000114 |
| Provider Name | Blanche Mokoso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356867360 PECOS PAC ID: 7214361062 Enrollment ID: I20201029001060 |
| Provider Name | Odelle Tsaya Kamani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699038174 PECOS PAC ID: 6709230725 Enrollment ID: I20230926000117 |
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