Provider Demographics
NPI:1225337504
Name:ACE MEDICAL CARE LLC
Entity Type:Organization
Organization Name:ACE MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIREBRAHIMI-TAFRESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-739-2315
Mailing Address - Street 1:9845 GEORGETOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2617
Mailing Address - Country:US
Mailing Address - Phone:703-757-0311
Mailing Address - Fax:
Practice Address - Street 1:9845 GEORGETOWN PIKE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2617
Practice Address - Country:US
Practice Address - Phone:703-757-0311
Practice Address - Fax:703-757-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247765261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center