1003888322 NPI number — TOTAL IMAGE CARE, INC

Table of content: (NPI 1548563950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003888322 NPI number — TOTAL IMAGE CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL IMAGE CARE, 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:
1003888322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 ARMY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-6701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-560-0614
Provider Business Mailing Address Fax Number:
410-560-0613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9103 FRANKLIN SQUARE DR
Provider Second Line Business Practice Location Address:
SUITE 1700
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-777-6302
Provider Business Practice Location Address Fax Number:
443-777-6309
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-560-0614

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MH24 . This is a "CAREFIRST BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F807 . This is a "CAREFIRST BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 601000800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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