Organization
MEDICAL COMPANY
Active
Organization
MEDICAL COMPANY
Active
Other names
MEDICAL COMPANY
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE FLEMING MCCLATCHEY IX (ADMINISTRATOR)
(703) 490-8106
Entity
Organization
Contact information
Practice address
14555 POTOMAC MILLS ROAD, WOODBRIDGE, VA 22192-5567
(703) 490-8106
(703) 490-8107
Mailing address
11690 CHANCEFORD DR, WOODBRIDGE, VA 22192-5567
(703) 490-8106
(703) 490-8107
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0206009192
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0206009192
DURABLE MEDICAL EQUIPMENT
VA
01
—
0215000305
WHOLESALE DISTRIBUTOR
VA
Enumeration date
12/21/2006
Last updated
08/22/2020
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