1134243603 NPI number — KEY POINT HEALTH SERVICES, INC

Table of content: (NPI 1134243603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134243603 NPI number — KEY POINT HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEY POINT HEALTH SERVICES, 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:
1134243603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 N PARKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21001-2428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-625-1588
Provider Business Mailing Address Fax Number:
443-625-1595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 DUNDALK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21222-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-633-2322
Provider Business Practice Location Address Fax Number:
410-633-0214
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEBER
Authorized Official First Name:
KARL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
443-625-1501

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2154 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 323P00000X , with the licence number: 2170 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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