Provider Demographics
NPI:1750610960
Name:FEDERAL BUREAU OF PRISONS
Entity type:Organization
Organization Name:FEDERAL BUREAU OF PRISONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHESNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-575-3900
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-4600
Mailing Address - Country:US
Mailing Address - Phone:919-575-3900
Mailing Address - Fax:919-575-4821
Practice Address - Street 1:OLD HWY 75
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509
Practice Address - Country:US
Practice Address - Phone:919-575-3900
Practice Address - Fax:919-575-4821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center