Healthcare Provider Details

I. General information

NPI: 1467450361
Provider Name (Legal Business Name): GATEX (FALLS CHURCH) INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W BROAD ST
FALLS CHURCH VA
22046-3137
US

IV. Provider business mailing address

PO BOX 6512
MC LEAN VA
22106-6512
US

V. Phone/Fax

Practice location:
  • Phone: 703-538-1505
  • Fax: 703-538-1504
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. AFOLABI OJUMU
Title or Position: BUSINESS MANAGER
Credential:
Phone: 703-538-1505