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General NPI Number Information
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NPI Number | 1952492316
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Entity Type | Organization
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Legal Business Name | USCG MEDICAL CLINIC ELIZABETH CITY
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | COMDT CG-1122 U S 2100 2ND ST SW, SUITE 5314
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City | WASHINGTON
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State | DC
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Zip | 20593-0001
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Country | US
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Telephone | 252-335-6461
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Fax | 252-335-6255
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Provider Business Mailing Address
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Address Line | COMDT CG-1122 U S 2100 2ND ST SW, SUITE 5314
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City | WASHINGTON
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State | DC
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Zip | 20593-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TECHNICIAN
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Name | MR. JOSE ENRIQUE LEFEBRE JR.
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Credential | TECHNICIAN
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Telephone | 252-335-6461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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