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General NPI Number Information
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NPI Number | 1902383367
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Entity Type | Organization
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Legal Business Name | SOMATUS DIALYSIS OF MOUNT VERNON, LLC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 2501 PARKERS LN STE 100
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3209
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Country | US
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Telephone | 571-549-6040
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Fax |
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Provider Business Mailing Address
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Address Line | 1861 INTERNATIONAL DR STE 600
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City | MC LEAN
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State | VA
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Zip | 22102-4420
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Country | US
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Telephone | 703-712-6344
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | ALICIA PALMER
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Credential |
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Telephone | 202-236-7061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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