Provider Demographics
NPI:1871067207
Name:KAISER FOUNDATION HEALH PLAN OF THE MID-ATLANTIC STATES INC.
Entity type:Organization
Organization Name:KAISER FOUNDATION HEALH PLAN OF THE MID-ATLANTIC STATES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPTH
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-816-5867
Mailing Address - Street 1:22370 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-5367
Mailing Address - Country:US
Mailing Address - Phone:703-466-4800
Mailing Address - Fax:
Practice Address - Street 1:3000 POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-3084
Practice Address - Country:US
Practice Address - Phone:703-721-6310
Practice Address - Fax:703-721-6320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HEALTH OF THE PLAN MID-ATLANTIC STATES,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-18
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy