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EXECUTIVE HEALTHCARE SERVICES PLLC NPI 1760664007


NPI Information

NPI: 1760664007
Provider Name: EXECUTIVE HEALTHCARE SERVICES PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 49D2159857

Address:
12040 S LAKES DR
SUITE 195
RESTON, VA
ZIP 20191
Phone: (703) 230-0347
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EXECUTIVE HEALTHCARE SERVICES PLLC is a family medicine in Reston, VA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. EXECUTIVE HEALTHCARE SERVICES PLLC NPI is 1760664007. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

12040 S LAKES DR
SUITE 195
RESTON, VA
ZIP 20191
Phone: (703) 230-0347
Fax: (703) 230-0350

The provider's authorized official is Cheryl Eccleston .
The authorized official title is Administrator and has the following contact phone number (703) 230-0347.

The CLIA number assigned to this NPI record is 49D2159857 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/28/2007 and was last updated on 8/25/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine0101050406VIRGINIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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