Healthcare Provider Details

I. General information

NPI: 1356660773
Provider Name (Legal Business Name): NORTHSIDE MEDICAL SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 MINNESOTA AVE NE
WASHINGTON DC
20019-3572
US

IV. Provider business mailing address

4121 MINNESOTA AVE NE
WASHINGTON DC
20019-3572
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-6000
  • Fax: 202-388-6001
Mailing address:
  • Phone: 202-388-6000
  • Fax: 202-388-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberMD037802
License Number StateDC

VIII. Authorized Official

Name: MR. RALPH O. TURNER
Title or Position: FACILITY MANAGER
Credential: RN
Phone: 202-388-6000