1184174252 NPI number — SILVER SPRING HEALTH CARE MANAGEMENT, INC.

Table of content: (NPI 1184174252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184174252 NPI number — SILVER SPRING HEALTH CARE MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER SPRING HEALTH CARE MANAGEMENT, 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:
SCMG BREAST HEALTH CLINIC
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:
1184174252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAKEFIELD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02880-0229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-788-8757
Provider Business Mailing Address Fax Number:
401-782-9867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 KENYON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02879-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-788-3337
Provider Business Practice Location Address Fax Number:
401-783-1872
Provider Enumeration Date:
10/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
POLHEMUS
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
401-788-1974

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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