MEDICARE: NAVAL INFORMATION OPERATIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1102X	Military Outpatient Operational (Transportable) Component Clinic/Center

General Provider Information

NPI Number	:	1558567511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVAL INFORMATION OPERATIONS

Provider Business Mailing Address
First Line	:	8901 WISCONSIN AVE
Second Line	:	PSC BOX 509 CODE 6300
City	:	BETHESDA
State	:	MD
Zip	:	20889-0001
Country	:	US
Telephone Number	:	301-295-4934
Fax Number	:	301-295-1299

Provider Business Practice Location Address
First Line	:	63 HEDRICK DR
Second Line	:
City	:	SUGAR GROVE
State	:	WV
Zip	:	26815-5000
Country	:	US
Telephone Number	:	304-249-6380
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISOR REVENUE COLLECTION
Name	:	MARCIA DICKSON
Credential	:
Telephone Number	:	301-295-4934

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	07/11/2008

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Directions to “NAVAL INFORMATION OPERATIONS ” Practice Location

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