| |
1310 Southern Ave Se Washington DC 20032-4623 | |
(202) 574-6837 | |
(202) 574-7188 |
Full Name | |
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Speciality | General Practice |
Location | 1310 Southern Ave Se, Washington, District Of Columbia |
Authorized Official Name and Position | John Montois (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 2025746837 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1310 Southern Ave Se Washington DC 20032-4623 Ph: (202) 574-6837 | 1310 Southern Ave Se Washington DC 20032-4623 Ph: (202) 574-6837 |
NPI Number | 1871756817 |
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Provider Enumeration Date | 07/09/2008 |
Last Update Date | 05/21/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871756817 | NPI | - | NPPES |
090008 | Other | DC | MEDICARE ACUTE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | HFDO10198 (District Of Columbia) | Primary |
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