=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033279666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL PROFESSIONALS ON-CALL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10875 MAIN ST STE 112
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-4732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-273-8818
-----------------------------------------------------
Fax | 703-273-8874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10875 MAIN ST STE 112
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-4732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-273-8818
-----------------------------------------------------
Fax | 703-273-8874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. HAGAR WIAFE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 703-273-8818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-07215
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------