Professional Healthcare Group

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0206009192 Issued in VA

Legal business name

PROFESSIONAL HEALTHCARE GROUP

Practice address

5504 Staples Mill PLZ
Woodbridge, VA 22193-3247

Phone

(703) 580-7192

Fax

(703) 580-7183

NPI assigned

May 23, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Annette Fleming McClatchey

Title

Administrator

Phone

(703) 580-7192

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222992000000",
    "number": "1689629255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6400",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221956400",
            "telephone_number": "703-490-8106",
            "fax_number": "703-580-7183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5504 STAPLES MILL PLZ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221933247",
            "telephone_number": "703-580-7192",
            "fax_number": "703-580-7183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL HEALTHCARE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-10-03",
        "status": "A",
        "authorized_official_last_name": "MCCLATCHEY",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_middle_name": "FLEMING",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-580-7192",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "VA",
            "license": "49D1010340",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "VA",
            "license": "0206009192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010280907",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010303524",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Woodbridge, VA
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• Durable Medical Equipment & Medical Supplies in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2008; 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.