Organization
WHITE EAGLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KHADIJA IDEMNATI (OWNER)
(703) 415-6603
Entity
Organization
Contact information
Practice address
4306 12TH RD S APT 1, ARLINGTON, VA 22204-3744
(703) 650-8982
(571) 970-3939
Mailing address
4306 12TH RD S APT 1, ARLINGTON, VA 22204-3744
(703) 650-8982
(571) 970-3939
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
07/07/2021
Last updated
07/07/2021
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