Healthcare Provider Details

I. General information

NPI: 1578634267
Provider Name (Legal Business Name): INOVA HEALTH SYSTEM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CAMERON GLEN DR
RESTON VA
20190-3308
US

IV. Provider business mailing address

9900 MAIN ST SECOND FLOOR
FAIRFAX VA
22031-3907
US

V. Phone/Fax

Practice location:
  • Phone: 703-834-5800
  • Fax: 703-834-5905
Mailing address:
  • Phone: 703-279-4353
  • Fax: 703-279-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberNH2593
License Number StateVA

VIII. Authorized Official

Name: ROBERT HAGER
Title or Position: SENIOR ADMINISTRATOR
Credential:
Phone: 703-279-4252