Provider Demographics
NPI:1326502410
Name:GUH KIDS MOBILE MEDICAL CLINIC PROGRAM, LLC
Entity Type:Organization
Organization Name:GUH KIDS MOBILE MEDICAL CLINIC PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-558-1403
Mailing Address - Street 1:2000 15TH ST N STE 600
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2900
Mailing Address - Country:US
Mailing Address - Phone:703-558-1217
Mailing Address - Fax:703-558-1445
Practice Address - Street 1:1601 16TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5503
Practice Address - Country:US
Practice Address - Phone:202-724-5539
Practice Address - Fax:866-269-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty