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128 M St Nw Washington DC 20001-1205 | |
| (202) 682-3840 | |
| (202) 682-3854 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 128 M St Nw, Washington, District Of Columbia |
| Authorized Official Name and Position | Beau Higginbotham (VICE PRESIDENT/COO) |
| Authorized Official Contact | 4106383162 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1150 Varnum St Ne Rm 407 Washington DC 20017-2180 Ph: (202) 854-4069 | 128 M St Nw Washington DC 20001-1205 Ph: (202) 682-3840 |
| NPI Number | 1619245222 |
|---|---|
| Provider Enumeration Date | 12/09/2011 |
| Last Update Date | 02/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619245222 | NPI | - | NPPES |
| 023435102 | Medicaid | DC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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