1285691527 NPI number — PRINCE GEORGE'S COUNTY MARYLAND

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285691527 NPI number — PRINCE GEORGE'S COUNTY MARYLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCE GEORGE'S COUNTY MARYLAND
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:
6
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:
1285691527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 719325
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19171-9325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-333-6768
Provider Business Mailing Address Fax Number:
833-953-0588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9201 BASIL CT STE 452
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20774-5343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-883-5240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
WARREN 'TONY'
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DEPUTY FIRE CHIEF -EMS
Authorized Official Telephone Number:
301-883-5210

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 428628600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992 0001 . This is a "BC OF NATL CAPITAL AREA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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