Provider Demographics
NPI:1811216583
Name:CAPITAL BREAST CARE CENTER
Entity Type:Organization
Organization Name:CAPITAL BREAST CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-784-2707
Mailing Address - Street 1:650 PENNSYLVANIA AVE SE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4318
Mailing Address - Country:US
Mailing Address - Phone:202-784-2700
Mailing Address - Fax:202-784-2722
Practice Address - Street 1:650 PENNSYLVANIA AVE SE
Practice Address - Street 2:SUITE 230
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4318
Practice Address - Country:US
Practice Address - Phone:202-784-2700
Practice Address - Fax:202-784-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC82001962001261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC025178300Medicaid