1114972031 NPI number — MARYLAND INPATIENT MEDICINE ASSOCIATES LLC

Table of content: (NPI 1114972031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114972031 NPI number — MARYLAND INPATIENT MEDICINE ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND INPATIENT MEDICINE ASSOCIATES 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:
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:
1114972031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 96368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73143-6368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-441-8500
Provider Business Mailing Address Fax Number:
676-784-4186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-822-1000
Provider Business Practice Location Address Fax Number:
410-770-3721
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMICK
Authorized Official First Name:
TALBOT
Authorized Official Middle Name:
GREEN
Authorized Official Title or Position:
PRESIDENT - CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
678-441-8500

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 356CMA . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: DF5634 . This is a "RR MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 412823100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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