1659391068 NPI number — MERITUS MEDICAL CENTER INC

Table of content: (NPI 1659391068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659391068 NPI number — MERITUS MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERITUS MEDICAL CENTER 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:
MERITUS TOTAL REHAB 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:
1659391068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11116 MEDICAL CAMPUS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21742-6710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-790-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11110 MEDICAL CAMPUS RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21742-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-714-4025
Provider Business Practice Location Address Fax Number:
301-714-4026
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REPAC
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
301-790-9351

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  21-012 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LY96 . This is a "BLUECROSS-MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 220598000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 219608500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 221728700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: W770 . This is a "BLUECROSS-FEP/GHMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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