Healthcare Provider Details

I. General information

NPI: 1700061504
Provider Name (Legal Business Name): CAPITOL MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

V. Phone/Fax

Practice location:
  • Phone: 202-574-6837
  • Fax: 202-574-7188
Mailing address:
  • Phone: 202-574-6837
  • Fax: 202-574-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberHFDO1-0198
License Number StateDC

VIII. Authorized Official

Name: MR. JOHN MONTOIS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 202-574-6837