=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538870191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INOVA HEALTH CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2022
-----------------------------------------------------
Last Update Date | 12/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3800 FETTLER PARK DR STE 312
-----------------------------------------------------
City | DUMFRIES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22025-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-472-6791
-----------------------------------------------------
Fax | 571-665-6791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 37174
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21297-3174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-423-5699
-----------------------------------------------------
Fax | 571-423-5698
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | ALICE POPE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 571-472-8717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0127X
-----------------------------------------------------
Taxonomy Name | Trauma Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 204F00000X
-----------------------------------------------------
Taxonomy Name | Transplant Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------