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NPI Code Detail

MEDICARE: COMMUNITY INTEGRATED CARE MANAGEMENT

MEDICARE: COMMUNITY INTEGRATED CARE MANAGEMENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2261QC1500XCommunity Health Clinic/Center

General Provider Information

NPI Number : 1053525824
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY INTEGRATED CARE MANAGEMENT
Provider Business Mailing Address
First Line : 1615 RHODE ISLAND AVE NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20018-1802
Country : US
Telephone Number : 202-269-4511
Fax Number : 202-269-3895
Provider Business Practice Location Address
First Line : 1615 RHODE ISLAND AVE NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20018-1802
Country : US
Telephone Number : 202-269-4511
Fax Number : 202-269-3895
Authorized Official
Title or Position : COO
Name : MR. MICHAEL MCCONNELL
Credential :
Telephone Number : 703-955-0544
Provider Enumeration Date : 05/10/2007
Last Update Date : 02/27/2018

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Directions to “COMMUNITY INTEGRATED CARE MANAGEMENT ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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