Healthcare Provider Details

I. General information

NPI: 1881308682
Provider Name (Legal Business Name): FEDSERVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 FRANKLIN FARMS DR RM 102
RICHMOND VA
23229-5107
US

IV. Provider business mailing address

8003 FRANKLIN FARMS DR RM 102
RICHMOND VA
23229-5107
US

V. Phone/Fax

Practice location:
  • Phone: 301-841-5077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ODUKOYA
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 301-841-5077