Provider Demographics
NPI:1740464510
Name:MEDICAL COMPANY
Entity type:Organization
Organization Name:MEDICAL COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
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:
Authorized Official - Phone:703-490-4114
Mailing Address - Street 1:PO BOX 6577
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22195-6577
Mailing Address - Country:US
Mailing Address - Phone:703-490-4114
Mailing Address - Fax:703-490-8107
Practice Address - Street 1:14555 POTOMAC MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6808
Practice Address - Country:US
Practice Address - Phone:703-490-4114
Practice Address - Fax:703-490-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009371332B00000X, 332BX2000X
VA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1801950894Medicaid