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Organization
MEDICAL COMPANY
Active
Organization
MEDICAL COMPANY
Active
Other names
medical company
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNETTE FLEMING MCCLATCHEY (PRESIDENT/CEO)
(703) 490-4114
Entity
Organization
Contact information
Practice address
14555 POTOMAC MILLS RD, WOODBRIDGE, VA 22192-6808
(703) 490-4114
(703) 490-8107
Mailing address
PO BOX 6577, WOODBRIDGE, VA 22195-6577
(703) 490-4114
(703) 490-8107
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
VA
332B00000X
Durable Medical Equipment & Medical Supplies
0206009371
VA
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0206009371
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801950894
—
VA
Enumeration date
12/28/2007
Last updated
12/28/2007
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