Provider Demographics
NPI:1831237072
Name:HOSPITAL & CRITICAL CARE SPECIALISTS OF LOUDOUN, PLC
Entity type:Organization
Organization Name:HOSPITAL & CRITICAL CARE SPECIALISTS OF LOUDOUN, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:INAKI
Authorized Official - Last Name:MENDIGUREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-669-5962
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:VA
Mailing Address - Zip Code:20197-0386
Mailing Address - Country:US
Mailing Address - Phone:703-669-5962
Mailing Address - Fax:703-669-5963
Practice Address - Street 1:44045 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5101
Practice Address - Country:US
Practice Address - Phone:703-585-6000
Practice Address - Fax:703-858-6610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005858160Medicaid
VA005858160Medicaid
C09801Medicare PIN