Provider Demographics
NPI:1396834321
Name:EAGLE MEDICAL
Entity Type:Organization
Organization Name:EAGLE MEDICAL
Other - Org Name:EAGLE MEDICAL,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIMA
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:EKPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-639-0250
Mailing Address - Street 1:635 FLORIDA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1875
Mailing Address - Country:US
Mailing Address - Phone:202-639-0250
Mailing Address - Fax:202-639-0251
Practice Address - Street 1:635 FLORIDA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1875
Practice Address - Country:US
Practice Address - Phone:202-639-0250
Practice Address - Fax:202-639-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC038503600Medicaid
MD014868700Medicaid
VA1396834321Medicaid
DC038503600Medicaid