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General NPI Number Information
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NPI Number | 1407187495
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Entity Type | Organization
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Legal Business Name | NORTHSIDE MEDICAL SERVICES CORPORATION
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 4121 MINNESOTA AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-3572
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Country | US
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Telephone | 202-388-6000
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Fax | 202-388-6001
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Provider Business Mailing Address
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Address Line | 4121 MINNESOTA AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-3572
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Country | US
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Telephone | 202-388-6000
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Fax | 202-388-6001
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Authorized Official
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Title or Position | CHEIF CONSULTING OFFICER
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Name | MR. RALPH O. TURNER
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Credential | RN
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Telephone | 202-388-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | MD 25334
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License Number State | DC
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