MEDICARE: GREAT FALLS MEDICAL CENTER, LLC

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	207Q00000X	Family Medicine Physician	0101244972	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689916991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT FALLS MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	1142 WALKER RD STE C
Second Line	:
City	:	GREAT FALLS
State	:	VA
Zip	:	22066-1836
Country	:	US
Telephone Number	:	703-534-3331
Fax Number	:	703-534-0704

Provider Business Practice Location Address
First Line	:	1142 WALKER RD STE C
Second Line	:
City	:	GREAT FALLS
State	:	VA
Zip	:	22066-1836
Country	:	US
Telephone Number	:	703-534-3331
Fax Number	:	703-534-0704

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. HIEU VAN HO
Credential	:	M.D.
Telephone Number	:	703-534-3331

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	03/25/2013

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