Provider Demographics
NPI:1467450361
Name:GATEX (FALLS CHURCH) INC.
Entity Type:Organization
Organization Name:GATEX (FALLS CHURCH) INC.
Other - Org Name:FALLS CHURCH URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AFOLABI
Authorized Official - Middle Name:
Authorized Official - Last Name:OJUMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-538-1505
Mailing Address - Street 1:PO BOX 6512
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22106-6512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 W BROAD ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3137
Practice Address - Country:US
Practice Address - Phone:703-538-1505
Practice Address - Fax:703-538-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA384078OtherANTHEM
G00711Medicare PIN