1649207168 NPI number — ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC.

Table of content: (NPI 1649207168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649207168 NPI number — ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, 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:
NORTH COUNTY EXPRESS CARE
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:
1649207168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 527
Provider Second Line Business Mailing Address:
25500 POINT LOOKOUT ROAD
Provider Business Mailing Address City Name:
LEONARDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-475-6044
Provider Business Mailing Address Fax Number:
410-882-3310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37767 MARKET DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE HALL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-290-1499
Provider Business Practice Location Address Fax Number:
410-882-3310
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRAAM
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT/CFO
Authorized Official Telephone Number:
301-475-6003

Provider Taxonomy Codes

  • Taxonomy code: 146N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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