Healthcare Provider Details

I. General information

NPI: 1548617863
Provider Name (Legal Business Name): RESTON HOSPITAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3219
US

IV. Provider business mailing address

1850 TOWN CENTER PKWY
RESTON VA
20190-3219
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax: 703-689-9179
Mailing address:
  • Phone: 703-689-9000
  • Fax: 703-689-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471C1101X
TaxonomyCardiovascular-Interventional Technology Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS EISEL
Title or Position: CFO
Credential:
Phone: 703-689-9000