Individual ProviderTheodore EckertNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3600 Joseph Siewick Dr, #202, Fairfax, VA 22033-1709(703) 922-9501(703) 295-9360PECOS EnrollmentBased on the most recent information from CMS, provider Theodore Eckert does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1891880670Provider TypeIndividualFull NameEckert, TheodoreTitleMr.CredentialCRNAGenderMaleSole ProprietorNoEnumeration Date10/4/2006Last Updated4/28/2015Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, #202, Fairfax, VA 22033-1709Phone(703) 922-9501Fax(703) 295-9369Mailing LocationMailing Address3998 Fair Ridge Dr, Suite 300, Fairfax, VA 22033-2921Phone(703) 295-9360Fax(703) 766-9725Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024165695VirginiaProvider IdentifiersIDDescriptionIssuerID297579DescriptionOtherIssuerAMERIGROUPVirginiaID139180DescriptionOtherIssuerANTHEMVirginiaID1891880670DescriptionMedicaidIssuerUnlistedVirginiaID562605DescriptionOtherIssuerNCPPOVirginiaIDK142-0002DescriptionOtherIssuerCAREFIRSTDistrict of Columbia