Organization
PROFESSIONAL HEALTHCARE GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNETTE FLEMING MCCLATCHEY (ADMINISTRATOR)
(703) 580-7192
Entity
Organization
Contact information
Practice address
5504 STAPLES MILL PLZ, WOODBRIDGE, VA 22193-3247
(703) 580-7192
(703) 580-7183
Mailing address
PO BOX 6400, WOODBRIDGE, VA 22195-6400
(703) 490-8106
(703) 580-7183
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
49D1010340
VA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0206009192
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010280907
—
VA
05
—
010303524
—
VA
Enumeration date
05/23/2006
Last updated
10/03/2008
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