1508946047 NPI number — WICOMICO COUNTY HEALTH DEPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508946047 NPI number — WICOMICO COUNTY HEALTH DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WICOMICO COUNTY HEALTH DEPT
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:
1508946047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801-4921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-543-6931
Provider Business Mailing Address Fax Number:
410-543-6975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 N SALISBURY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-334-3401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BREWSTER
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
410-543-6930

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 400155900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 901100360 . This is a "DORAL DENTAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 113970-1 . This is a "DENTAL BENEFIT PROVIDER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 409012800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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