1346341716 NPI number — WESTERN MARYLAND HEALTH SYSTEM CORPORATION

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 1346341716 NPI number — WESTERN MARYLAND HEALTH SYSTEM CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MARYLAND HEALTH SYSTEM CORPORATION
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:
1346341716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 HUNT CLUB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGELEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26753-7567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-726-4501
Provider Business Mailing Address Fax Number:
304-726-4051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 HUNT CLUB DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26753-7567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-726-4501
Provider Business Practice Location Address Fax Number:
304-726-4051
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REPAC
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SR VP CFO
Authorized Official Telephone Number:
240-964-8003

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810002358 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001304838 . This is a "MT. STATE BC BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: A05 LU39HU . This is a "CAREFIRST BC BS MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E458 . This is a "DC BC BS - BLUE CHOICE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: CN1324 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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