| Family Medical Center Holding Llc | |
|
14904 Jefferson Davis Hwy Ste 205 Woodbridge VA 22191-3908 | |
| (703) 497-4500 | |
| (703) 494-4671 |
| Full Name | Family Medical Center Holding Llc |
|---|---|
| Speciality | Pain Medicine |
| Location | 14904 Jefferson Davis Hwy Ste 205, Woodbridge, Virginia |
| Authorized Official Name and Position | Sallu Jabati (MD/MEDICAL DIRECTOR) |
| Authorized Official Contact | 7034974500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medical Center Holding Llc 14904 Jefferson Davis Hwy Ste 205 Woodbridge VA 22191-3908 Ph: (703) 497-4500 | Family Medical Center Holding Llc 14904 Jefferson Davis Hwy Ste 205 Woodbridge VA 22191-3908 Ph: (703) 497-4500 |
| NPI Number | 1548634678 |
|---|---|
| Provider Enumeration Date | 12/01/2015 |
| Last Update Date | 12/01/2015 |
| Medicare PECOS PAC ID | 5193029858 |
|---|---|
| Medicare Enrollment ID | O20160201002390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548634678 | NPI | - | NPPES |
| Provider Name | Sallu M Jabati |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1235104431 PECOS PAC ID: 4486683141 Enrollment ID: I20160201002567 |
| Provider Name | Ruby Anumah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255698635 PECOS PAC ID: 7810150885 Enrollment ID: I20160202001548 |
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