1356459747 NPI number — MAXIM HEALTHCARE SERVICES, INC.

Table of content: (NPI 1356459747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356459747 NPI number — MAXIM HEALTHCARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAXIM HEALTHCARE SERVICES, INC.
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:
1356459747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7227 LEE DEFOREST DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-910-1500
Provider Business Mailing Address Fax Number:
410-910-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 EAST COLISEUM BLVD.
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
FT. WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-432-1166
Provider Business Practice Location Address Fax Number:
260-436-3914
Provider Enumeration Date:
08/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRICKHOUSE
Authorized Official First Name:
DUANE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
410-910-1500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  003757-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 164297 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200484160A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2475521 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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