1023058062 NPI number — MCCREADY FOUNDATION, INC

Table of content: (NPI 1023058062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023058062 NPI number — MCCREADY FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCREADY FOUNDATION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCCREADY OUTPATIENT SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023058062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 HALL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRISFIELD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21817-1237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-968-1200
Provider Business Mailing Address Fax Number:
410-968-1025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 HALL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRISFIELD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-968-1200
Provider Business Practice Location Address Fax Number:
410-968-1025
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
410-968-1200

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KZ01 . This is a "MD BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T524 . This is a "DC BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 49827 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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