Provider Demographics
NPI:1285786228
Name:INOVA HEALTH CARE SERVICES
Entity type:Organization
Organization Name:INOVA HEALTH CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-472-8717
Mailing Address - Street 1:8095 INNOVATION PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4868
Mailing Address - Country:US
Mailing Address - Phone:540-272-7378
Mailing Address - Fax:
Practice Address - Street 1:224 CORNWALL ST NW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2701
Practice Address - Country:US
Practice Address - Phone:703-858-6000
Practice Address - Fax:703-858-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA19802001273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1376564302Medicaid
VA49S043Medicare ID - Type Unspecified