Basic Information
| Provider Information | |||||||||
| NPI: | 1578634267 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INOVA HEALTH SYSTEM SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9900 MAIN ST | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220313907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032794353 | ||||||||
| FaxNumber: | 7032794210 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 CAMERON GLEN DR | ||||||||
| Address2: | |||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201903308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038345800 | ||||||||
| FaxNumber: | 7038345905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HAGER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7032794252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BN1400X | NH2593 | VA | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies |
No ID Information.