NPIMap

Organization Active NPI

Coast Guard

  • Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
  • Washington, DC
National Provider Identifier
1528142809
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military and U.S. Coast Guard Ambulatory Procedure Clinic/CenterTaxonomy code 261QM1101X
Legal business name
COAST GUARD
Practice address
Comdt CG-1122 2100 2ND St SW
Suite 5314
Washington, DC 20593-0001
Phone
(508) 968-6572
Fax
(508) 968-6581
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard A Jackson
Title
Supervisor
Phone
(508) 968-6713

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center 261QM1101X Primary

Addresses

Primary practice location

Comdt CG-1122 2100 2ND St SW
Suite 5314
Washington, DC 20593-0001

Mailing address

Comdt CG-1122 2100 2ND St SW
Suite 5314
Washington, DC 20593-0001
Phone (508) 968-6572

National Provider Directory

National Provider Directory
Tax ID family
Coast Guard2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528142809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "COMDT CG-1122 2100 2ND ST SW",
            "address_2": "SUITE 5314",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "205930001",
            "telephone_number": "508-968-6572",
            "fax_number": "508-968-6581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COMDT CG-1122 2100 2ND ST SW",
            "address_2": "SUITE 5314",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "205930001",
            "telephone_number": "508-968-6572",
            "fax_number": "508-968-6581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST GUARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "508-968-6713"
    },
    "taxonomies": [
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.