Provider Demographics
NPI:1235518226
Name:MEDSERV MEDICAL MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:MEDSERV MEDICAL MANAGEMENT SERVICES LLC
Other - Org Name:MEDICAL AND VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ORELLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-208-1384
Mailing Address - Street 1:8243 SHOPPERS SQ
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-2176
Mailing Address - Country:US
Mailing Address - Phone:571-208-1384
Mailing Address - Fax:571-208-1542
Practice Address - Street 1:8243 SHOPPERS SQ
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2176
Practice Address - Country:US
Practice Address - Phone:571-208-1384
Practice Address - Fax:571-208-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246564261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service