# CCRM NORTHERN VIRGINIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598297269
- **Authorized official:** MATT TYSON (DIRECTOR, MANAGED CARE CONTRACTING)
- **Authorized official phone:** (615) 477-6677

## Contact information

- **Practice address:** 8010 TOWERS CRESCENT DR, 5TH FLOOR, VIENNA, VA 22182-2710
- **Practice address phone:** (571) 789-2100
- **Mailing address:** 8010 TOWERS CRESCENT DR FL 5, VIENNA, VA 22182-2710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA0006X | Ambulatory Fertility Facility | — | NULL | Yes |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/31/2017
- **Last updated:** 07/13/2026