Healthcare Provider Details

I. General information

NPI: 1477794576
Provider Name (Legal Business Name): ETHIO-AMERICAN HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 14TH ST NW
WASHINGTON DC
20011-4358
US

IV. Provider business mailing address

PO BOX 21425
WASHINGTON DC
20009-0925
US

V. Phone/Fax

Practice location:
  • Phone: 202-607-1763
  • Fax:
Mailing address:
  • Phone: 202-607-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD034563
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD034616
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD035167
License Number StateDC

VIII. Authorized Official

Name: PAIGE SMITH
Title or Position: BILLING MANAGER
Credential:
Phone: 301-509-4091