1205885746 NPI number — GLASGOW MEDICAL CENTER, LLC

Table of content: (NPI 1205885746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205885746 NPI number — GLASGOW MEDICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLASGOW MEDICAL CENTER, 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:
GLASGOW AMBULATORY SURGERY CENTER
Provider Other Organization Name Type Code:
5
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:
1205885746
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:
2600 GLASGOW AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-4777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-836-8350
Provider Business Mailing Address Fax Number:
302-836-1906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 GLASGOW AVE
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19702-4777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-836-8350
Provider Business Practice Location Address Fax Number:
302-836-1906
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRETZ
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
C
Authorized Official Title or Position:
C.O.O.
Authorized Official Telephone Number:
302-836-8350

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  FSSC 003 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0004763000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 73291 . This is a "COVENTRY HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 249428 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 165981 . This is a "BCBSDE PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0094313 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9846333 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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