Provider Demographics
NPI:1336219104
Name:MEDCO
Entity Type:Organization
Organization Name:MEDCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:FLEMING
Authorized Official - Last Name:MCCLATCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:703-490-8106
Mailing Address - Street 1:14470 SMOKETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4712
Mailing Address - Country:US
Mailing Address - Phone:703-490-5980
Mailing Address - Fax:703-490-8107
Practice Address - Street 1:14470 SMOKETOWN RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4712
Practice Address - Country:US
Practice Address - Phone:703-490-5980
Practice Address - Fax:703-490-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009192332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies