1609990258 NPI number — ALLEGANY COUNTY HEALTH DEPARTMENT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609990258 NPI number — ALLEGANY COUNTY HEALTH DEPARTMENT

Employer Identification Number (EIN):

Provider Organization Name:

ALLEGANY COUNTY HEALTH DEPARTMENT

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

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:

1609990258

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

07/16/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 1745

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CUMBERLAND

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21501-1745

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

301-759-5000

Provider Business Mailing Address Fax Number:

301-777-5674

Provider First Line Business Practice Location Address:

12501 WILLOWBROOK RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CUMBERLAND

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21502-2554

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

301-759-5093

Provider Business Practice Location Address Fax Number:

301-777-5669

Provider Enumeration Date:

03/19/2007

Authorized Official Last Name:

RAVER

Authorized Official First Name:

SUE

Authorized Official Middle Name:

Authorized Official Title or Position:

HEALTH OFFICER

Authorized Official Telephone Number:

301-759-5001

• Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 323817 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 147701060 . This is a "MPC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: K002K0 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 1059446 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 55752NO . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 8480502 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 702001500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 720001300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 0180409 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 351541 . This is a "MAMSI (MDIPA, MAMSI LIFE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: NU1 . This is a "GHMSI (FEP, BLUE CHOICE)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: VA01 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".