Provider Demographics
NPI:1184616617
Name:WHITMAN-WALKER CLINIC, INC
Entity type:Organization
Organization Name:WHITMAN-WALKER CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-797-4428
Mailing Address - Street 1:1377 R ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6293
Mailing Address - Country:US
Mailing Address - Phone:202-745-7000
Mailing Address - Fax:202-797-3504
Practice Address - Street 1:1525 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3706
Practice Address - Country:US
Practice Address - Phone:202-745-7000
Practice Address - Fax:202-797-3504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITMAN-WALKER CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33659261QC1500X
261Q00000X, 261QC1500X, 261QD0000X, 261QM0801X, 261QM0850X, 261QF0400X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC034298100Medicaid
DC038798600Medicaid
DC038947600Medicaid
DC022385400Medicaid
G89101Medicare UPIN
DC034298100Medicaid
DC19666OtherDCCHARTERED HEALTH PLAN
DC022379800Medicaid
DC038947600Medicaid