Provider Demographics
NPI:1760903454
Name:GEORGE WASHINGTON UNIVERSITY
Entity Type:Organization
Organization Name:GEORGE WASHINGTON UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMRI
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-994-5301
Mailing Address - Street 1:800 21ST ST NW FL COLONIAL
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20052-0028
Mailing Address - Country:US
Mailing Address - Phone:202-994-5300
Mailing Address - Fax:
Practice Address - Street 1:800 21ST ST NW FL COLONIAL
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20052-0028
Practice Address - Country:US
Practice Address - Phone:202-994-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE WASHINGTON UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center