1194844357 NPI number — METROSPINE PC

Table of content: (NPI 1194844357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194844357 NPI number — METROSPINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROSPINE PC
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:
1194844357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6196 OXON HILL
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
OXON HILL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20745-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-567-2100
Provider Business Mailing Address Fax Number:
301-567-2399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6196 OXON HILL
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
OXON HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20745-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-567-2100
Provider Business Practice Location Address Fax Number:
301-567-2399
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DRAKES
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
HUDSON
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-856-5860

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  2816 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 4331 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 2569 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: D0042188 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 18045 , 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: S120-0001 . This is a "CAREFIRST BLUECROSS BLUES" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4162340001 . This is a "METROSPINE MD MEDICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: DD2519 . This is a "MEDICARE RAILROAD #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 00B 111C40 . This is a "MEDICARE INDIVIDUAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 168621600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 043570100 . This is a "DR DRAKES DC MEDICAID" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 055880600 . This is a "DC MEDICAID METRO SPINE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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