1386643856 NPI number — DYNASPLINT SYSTEMS, INC

Table of content: (NPI 1386643856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386643856 NPI number — DYNASPLINT SYSTEMS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNASPLINT SYSTEMS, 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:
1386643856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 RITCHIE HIGHWAY
Provider Second Line Business Mailing Address:
SUITE W-21
Provider Business Mailing Address City Name:
SEVERNA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21146-4152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-638-6771
Provider Business Mailing Address Fax Number:
800-380-3784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 RITCHIE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE W-21
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146-4152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-638-6771
Provider Business Practice Location Address Fax Number:
800-380-3784
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEPBURN
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-638-6771

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1121034 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: 1121034 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ---------002 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015125780004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200378120A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3088748 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9800010000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00440443 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100503478 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258948600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90092396 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000F4585 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0872541-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81023300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: MS53MD , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: ---------00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0253470 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0689189 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000040699 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386643856 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213193 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100798260A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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