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OLD TOWN MANASSAS MEDICAL CENTER
NPI 1184027161
Clinic/Center in Manassas, VA

Active since October 03, 2014CLIA 49D1060000 · Waiver
9003 CHURCH ST, MANASSAS, VA 20110(703) 365-0397(703) 365-0399 Get Directions Write a Review

NPPES record last updated: October 3, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Old Town Manassas Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OLD TOWN MANASSAS MEDICAL CENTER (NPI 1184027161) is a healthcare organization registered as a clinic/center in Manassas, Virginia and active in the NPI registry since October 2014. The organization holds a CLIA Waiver certificate valid through October 11, 2026 and lists Flaviano Dazo, Owner, as its authorized official.

NPPES Registry Identity

NPI1184027161
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameOLD TOWN MANASSAS MEDICAL CENTER
Location Address9003 CHURCH STManassas, VA 20110-5410
Mailing Address9003 Church StManassas, VA 20110-5410 · (703) 365-0397 · Fax (703) 365-0399
Phone(703) 365-0397
Fax(703) 365-0399
Organization SubpartNo
Authorized OfficialFlaviano DazoOwner · (703) 365-0397
Enumeration DateOctober 3, 2014
✔ NPI 1184027161 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in VA · 0663198-0
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
9003 CHURCH ST, Manassas, VA 20110
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D1060000

Old Town Manassas Medical Center · Manassas, VA
Active · expires Oct 11, 2026
CLIA Number49D1060000
Laboratory TypePractitioner Other
Certificate Effective DateOctober 12, 2024
Certificate Expiration DateOctober 11, 2026
Laboratory DirectorFlaviano D. Dazo
Laboratory Phone(703) 365-0397
Laboratory LocationOld Town Manassas Medical Center9003 Church Street, Manassas, VA 20110
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JENNY S CHEUNG D.D.S.
Dentist (General Practice)
9003 CHURCH ST
MANASSAS, VA 20110
Manassas City (703) 369-2323

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Old Town Manassas Medical Center's NPI number?

The NPI number for Old Town Manassas Medical Center is 1184027161. It was assigned to this organization in the NPPES registry on October 3, 2014.

Where is Old Town Manassas Medical Center located?

Old Town Manassas Medical Center is located at 9003 Church St, Manassas, VA 20110. The listed phone number is (703) 365-0397.

What is Old Town Manassas Medical Center's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Old Town Manassas Medical Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D1060000) is associated with this NPI, valid through October 11, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Old Town Manassas Medical Center was last updated on October 3, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.