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General NPI Number Information
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NPI Number | 1013358878
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Entity Type | Organization
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Legal Business Name | HEALTH CONNECT ACO, LLC
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 12011 LEE JACKSON HWY SUITE 504
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City | FAIRFAX
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State | VA
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Zip | 22033-3310
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Country | US
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Telephone | 703-391-2042
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Fax |
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Provider Business Mailing Address
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Address Line | 12011 LEE JACKSON HWY SUITE 504
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City | FAIRFAX
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State | VA
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Zip | 22033-3310
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Country | US
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Telephone | 703-391-2042
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | LAURI RUSTAND
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Credential |
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Telephone | 703-391-2042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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