1972581825 NPI number — SOMERSET HEALTH SERVICES LLC

Table of content: (NPI 1972581825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972581825 NPI number — SOMERSET HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMERSET HEALTH SERVICES LLC
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:
CRISFIELD DISCOUNT PHARMACY
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:
1972581825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRISFIELD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21817-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-968-1660
Provider Business Mailing Address Fax Number:
410-968-9102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 W MAIN ST UNIT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRISFIELD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-968-1660
Provider Business Practice Location Address Fax Number:
410-968-9102
Provider Enumeration Date:
01/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YAHYA
Authorized Official First Name:
SHAH
Authorized Official Middle Name:
MOHAMMED
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
410-968-1660

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  14326 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P04174 , 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: 2132051 . This is a "NCPDP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 408862000 . This is a "MEDICAID DME" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 457383 . This is a "MD. CONTROL DRUG SUBSTANC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 003150000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P04174 . This is a "PHARMACY PERMIT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 010166268 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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