Provider Demographics
NPI:1144088758
Name:MAGNIFICUS CORPORATION GOVERNMENT SERVICES
Entity type:Organization
Organization Name:MAGNIFICUS CORPORATION GOVERNMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKINTOYE
Authorized Official - Middle Name:O
Authorized Official - Last Name:SHOETAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:202-838-8086
Mailing Address - Street 1:125A L STREET, SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003
Mailing Address - Country:US
Mailing Address - Phone:202-838-8086
Mailing Address - Fax:888-829-2131
Practice Address - Street 1:125A L STREET, SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:202-838-8086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty