1033123880 NPI number — ADVENTIST HEALTHCARE, INC

Table of content: (NPI 1033123880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033123880 NPI number — ADVENTIST HEALTHCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST HEALTHCARE, 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:
CAPITAL CHOICE PATHOLOGY LABORATORY
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:
1033123880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1350
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20725-1350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-471-3427
Provider Business Mailing Address Fax Number:
240-471-3401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12041 BOURNEFIELD WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20904-7907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-471-3427
Provider Business Practice Location Address Fax Number:
240-471-3401
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAFRINIERE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
240-471-3427

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  21D0649632 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2556057 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P001981611 . This is a "RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 010141125 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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