Provider Demographics
NPI:1053363853
Name:RESTON HOSPITAL CENTER LLC
Entity type:Organization
Organization Name:RESTON HOSPITAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EISEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-689-9000
Mailing Address - Street 1:1850 TOWN CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3219
Mailing Address - Country:US
Mailing Address - Phone:703-689-9000
Mailing Address - Fax:703-689-9179
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-689-9000
Practice Address - Fax:703-689-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0888526Medicaid
166413900OtherDEPT OF LABOR
435971OtherGEHA
GA000872946XMedicaid
3295OtherNYLCARE
NY01583522Medicaid
DC033172100Medicaid
MD063001200Medicaid
100742OtherKAISER
435971OtherALLIANCE
6560790OtherAETNA
719OtherWELLPOINT
FL913644400Medicaid
VA004901070Medicaid
SC10398AMedicaid
VA226610OtherWELLPOINT
ME431944200Medicaid
516336OtherNCPPO
IL=========001Medicaid
FL913644400Medicaid