Provider Demographics
NPI:1780468223
Name:BIVINS FAMILY LLC
Entity type:Organization
Organization Name:BIVINS FAMILY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DERECK
Authorized Official - Last Name:BIVINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-288-9573
Mailing Address - Street 1:1500 N GATE RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1220
Mailing Address - Country:US
Mailing Address - Phone:202-288-9573
Mailing Address - Fax:
Practice Address - Street 1:140 Q ST NE STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2101
Practice Address - Country:US
Practice Address - Phone:202-636-9411
Practice Address - Fax:202-636-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty