Provider Demographics
NPI:1316518574
Name:1530 MEDICAL SERVICES
Entity type:Organization
Organization Name:1530 MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OKONOFUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-269-6600
Mailing Address - Street 1:1160 VARNUM ST NE STE 218
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2106
Mailing Address - Country:US
Mailing Address - Phone:202-269-6600
Mailing Address - Fax:202-621-9564
Practice Address - Street 1:1160 VARNUM ST NE STE 218
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2106
Practice Address - Country:US
Practice Address - Phone:202-269-6600
Practice Address - Fax:202-621-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty