Provider Demographics
NPI:1326128448
Name:ADVENTIST PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:ADVENTIST PHYSICIAN SERVICES, INC
Other - Org Name:TAKOMA SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINEMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-315-3685
Mailing Address - Street 1:1801 RESEARCH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3152
Mailing Address - Country:US
Mailing Address - Phone:301-315-3685
Mailing Address - Fax:301-838-4928
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-891-6000
Practice Address - Fax:301-891-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02382Medicare PIN