1770691024 NPI number — ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC

Table of content: (NPI 1770691024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770691024 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:
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:
1770691024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 527
Provider Second Line Business Mailing Address:
HEALTH CONNECTIONS
Provider Business Mailing Address City Name:
LEONARDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20650-0527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-475-6185
Provider Business Mailing Address Fax Number:
301-475-6143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25500 POINT LOOKOUT RD
Provider Second Line Business Practice Location Address:
HEALTH CONNECTIONS
Provider Business Practice Location Address City Name:
LEONARDTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20650-0527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-475-6185
Provider Business Practice Location Address Fax Number:
301-475-6143
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUTAY
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
DIABETES EDUCATOR/DIETITIAN
Authorized Official Telephone Number:
301-475-6185

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  DO0679 , 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: 211539 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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