1083644918 NPI number — QA HEALTHCARE

Table of content: (NPI 1083644918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083644918 NPI number — QA HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QA HEALTHCARE
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:
Provider Other Organization Name Type Code:
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:
1083644918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15401 MCMULLEN HWY SW
Provider Second Line Business Mailing Address:
PO BOX 870
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-6200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-729-2515
Provider Business Mailing Address Fax Number:
301-723-1594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15401 MCMULLEN HWY SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-729-2515
Provider Business Practice Location Address Fax Number:
301-723-1594
Provider Enumeration Date:
07/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FARRIS
Authorized Official First Name:
FELIX
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPTROLLER
Authorized Official Telephone Number:
301-729-2515

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: Z491QA . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0146707000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".