Provider Demographics
NPI:1396291324
Name:CLIFTON HEALTH SYSTEMS LLC
Entity type:Organization
Organization Name:CLIFTON HEALTH SYSTEMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-422-4824
Mailing Address - Street 1:2825 MCGILL TER NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2749
Mailing Address - Country:US
Mailing Address - Phone:202-422-4824
Mailing Address - Fax:
Practice Address - Street 1:973 FEATHERSTONE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5912
Practice Address - Country:US
Practice Address - Phone:202-422-4824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD037774OtherLICENSE NUMBER