Provider Demographics
NPI:1578653721
Name:BUMED
Entity Type:Organization
Organization Name:BUMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER FOR SUBSTANCE ABUSE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-762-3016
Mailing Address - Street 1:2300 E ST NW CODE # M3C3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20372-0001
Mailing Address - Country:US
Mailing Address - Phone:202-762-3017
Mailing Address - Fax:202-762-3023
Practice Address - Street 1:2300 E ST NW CODE # M3B6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20372-0001
Practice Address - Country:US
Practice Address - Phone:202-762-3017
Practice Address - Fax:202-762-3023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 3927251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health