1467427047 NPI number — WESTERN MARYLAND HEALTH CARE CORPORATION

Table of content: (NPI 1467427047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467427047 NPI number — WESTERN MARYLAND HEALTH CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MARYLAND HEALTH CARE CORPORATION
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:
MOUNTAIN LAUREL MEDICAL CENTER
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:
1467427047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1027 MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21550-4343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-533-3300
Provider Business Mailing Address Fax Number:
301-533-3299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1027 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21550-4343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-533-3300
Provider Business Practice Location Address Fax Number:
301-533-3299
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-533-3300

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410467600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1030070260003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810007182 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7118 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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