IMMACULATE MEDICAL SERVICES LLC NPI 1821301904

NPI Information

NPI: 1821301904
Provider Name: IMMACULATE MEDICAL SERVICES LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 09D2033464

Address:
106 IRVING ST NW
SUITE 308 SOUTH
WASHINGTON, DC
ZIP 20010
Phone: (202) 877-0400
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IMMACULATE MEDICAL SERVICES LLC is a primary care clinic center in Washington, DC. IMMACULATE MEDICAL SERVICES LLC NPI is 1821301904. The provider is registered as an organization entity type.

The provider's business location address is:

106 IRVING ST NW
SUITE 308 SOUTH
WASHINGTON, DC
ZIP 20010-927
Phone: (202) 877-0400
Fax: (202) 877-0584

The provider's authorized official is Ann Marie Gordon .
The authorized official title is Ceo and has the following contact phone number (202) 877-0400.

The CLIA number assigned to this NPI record is 09D2033464 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/19/2010 and was last updated on 2/15/2011.

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
1	261QX0100X	Clinic/Center	Occupational Medicine	MD22148	DISTRICT OF COLUMBIA	No
2	261QP2300X	Clinic/Center	Primary Care	MD22148	DISTRICT OF COLUMBIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	491173	MEDICARE PIN	MARYLAND

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

NPI Synchronization or Removal

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