Provider Demographics
NPI:1598297269
Name:CCRM NORTHERN VIRGINIA, LLC
Entity Type:Organization
Organization Name:CCRM NORTHERN VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-885-5762
Mailing Address - Street 1:9380 STATION ST
Mailing Address - Street 2:STE 425
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6831
Mailing Address - Country:US
Mailing Address - Phone:303-968-1950
Mailing Address - Fax:
Practice Address - Street 1:8010 TOWERS CRESCENT DR
Practice Address - Street 2:5TH FLOOR
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2710
Practice Address - Country:US
Practice Address - Phone:571-789-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical