1164452991 NPI number — MAXIM HEALTHCARE SERVICES, INC.

Table of content: (NPI 1164452991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164452991 NPI number — MAXIM HEALTHCARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAXIM HEALTHCARE SERVICES, 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:
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:
1164452991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7227 LEE DEFOREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21046-3236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-910-1500
Provider Business Mailing Address Fax Number:
410-910-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4151 SYCAMORE DAIRY RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28303-3460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-485-2255
Provider Business Practice Location Address Fax Number:
866-326-5048
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRICKHOUSE
Authorized Official First Name:
DUANE
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL CONTROLLER
Authorized Official Telephone Number:
410-910-1500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC1995 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6600750 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3408463 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100403 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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