1285736207 NPI number — PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER

Table of content: (NPI 1285736207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285736207 NPI number — PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER
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:
PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER LLC
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:
1285736207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 OLD SOLOMONS ISLAND ROAD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ANNANPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-0902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-224-4448
Provider Business Mailing Address Fax Number:
443-949-9539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 OLD SOLOMONS ISLAND ROAD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ANNANPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-0902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-224-4448
Provider Business Practice Location Address Fax Number:
443-949-9539
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKEE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-224-4448

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1134 , 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: 336913 . This is a "FELRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 706667 . This is a "AETNA HMO TRADITIONAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 79740000 . This is a "FEDERAL EMPLOYEE PROGRAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6949277 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 706667 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 483463 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5147492 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 336913 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 336913 . This is a "MAMSI LIFE & HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 336913 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 402820100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 336913 . This is a "GEHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZ22 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 522197293 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60853301 . This is a "CAREFIRST BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NH8 . This is a "GHMSI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com