Provider Demographics
NPI:1578584306
Name:EMERALD MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:EMERALD MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:BEN
Authorized Official - Last Name:ODUNZEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-722-8877
Mailing Address - Street 1:4211 9TH ST NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7200
Mailing Address - Country:US
Mailing Address - Phone:202-722-8877
Mailing Address - Fax:202-722-8819
Practice Address - Street 1:4211 9TH ST NW
Practice Address - Street 2:SUITE 1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7200
Practice Address - Country:US
Practice Address - Phone:202-722-8877
Practice Address - Fax:202-722-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578584306Medicaid
DC5556280001Medicare NSC