Healthcare Provider Details

I. General information

NPI: 1235518226
Provider Name (Legal Business Name): MEDSERV MEDICAL MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8243 SHOPPERS SQ
MANASSAS VA
20111-2176
US

IV. Provider business mailing address

8243 SHOPPERS SQ
MANASSAS VA
20111-2176
US

V. Phone/Fax

Practice location:
  • Phone: 571-208-1384
  • Fax: 571-208-1542
Mailing address:
  • Phone: 571-208-1384
  • Fax: 571-208-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0101246564
License Number StateVA

VIII. Authorized Official

Name: MIGUEL E ORELLANA
Title or Position: PRESIDENT
Credential:
Phone: 571-208-1384