Provider Demographics
NPI:1710255047
Name:DEPARTMENT OF AGRICULTURE
Entity Type:Organization
Organization Name:DEPARTMENT OF AGRICULTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR OF OFFICE OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-720-4134
Mailing Address - Street 1:1400 INDEPENDENCE AVE SW
Mailing Address - Street 2:MEDICAL SERVICES - ROOM: 1409-SBLDG
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20250-0002
Mailing Address - Country:US
Mailing Address - Phone:202-720-3893
Mailing Address - Fax:202-720-6567
Practice Address - Street 1:1400 INDEPENDENCE AVE SW
Practice Address - Street 2:MEDICAL SERVICES - ROOM: 1409-SBLDG
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20250-0002
Practice Address - Country:US
Practice Address - Phone:202-720-3893
Practice Address - Fax:202-720-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD6710261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD 6710OtherDEA# BJ4717724, DC LICENSE # MD 6710