1871720797 NPI number — HELIXCARE MEDICAL GROUP, LLC

Table of content: (NPI 1871720797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871720797 NPI number — HELIXCARE MEDICAL GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HELIXCARE MEDICAL GROUP, LLC
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:
MEDSTAR PHYSICIAN PARTNERS AT THE ROTUNDA
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:
1871720797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 W 40TH ST
Provider Second Line Business Mailing Address:
SUITE 429
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21211-2120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-554-5437
Provider Business Mailing Address Fax Number:
410-554-5436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 W 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 429
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21211-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-554-5437
Provider Business Practice Location Address Fax Number:
410-554-5436
Provider Enumeration Date:
06/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
STEELE-WHITE
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CREDENTIALING ASSOCIATE
Authorized Official Telephone Number:
410-933-3073

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KT80 . This is a "CAREFIRST OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: CC3132 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W655 . This is a "CAREFIRST OF DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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