1861681488 NPI number — SOUTHERN MARYLAND HOSPITAL, INC

Table of content: (NPI 1861681488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861681488 NPI number — SOUTHERN MARYLAND HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MARYLAND HOSPITAL, 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:
DEPARTMENT OF NEUROLOGY
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:
1861681488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7503 SURRATTS ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-3358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-870-7001
Provider Business Mailing Address Fax Number:
301-870-6697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7503 SURRATTS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-3358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-870-7001
Provider Business Practice Location Address Fax Number:
301-870-6697
Provider Enumeration Date:
10/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
301-877-4541

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8308, LR78SO . This is a "CAREFIRST NCA & MARYLAND GROUP NUMBERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 410569900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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