1285691527 NPI number — PRINCE GEORGE'S COUNTY MARYLAND

Table of content: (NPI 1285691527)

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".




Copyright © 2007-2025 www.npivalidator.com