=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902064553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INOVA HEALTH SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2008
-----------------------------------------------------
Last Update Date | 05/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8003 FORBES PL SUITE 104
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22151-2207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-321-1997
-----------------------------------------------------
Fax | 170-332-1999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8003 FORBES PL SUITE 104
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22151-2207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-321-1997
-----------------------------------------------------
Fax | 170-332-1999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM MANAGER
-----------------------------------------------------
Name | MRS. JILL E CHRISTIANSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-321-1997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------