1386703718 NPI number — WESTERN MARYLAND HEALTH SYSTEM BRADDOCK HOSPITAL CORPORATION

Table of content: (NPI 1386703718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386703718 NPI number — WESTERN MARYLAND HEALTH SYSTEM BRADDOCK HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MARYLAND HEALTH SYSTEM BRADDOCK HOSPITAL 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:
1386703718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 SETON DR
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-723-6365
Provider Business Mailing Address Fax Number:
301-723-6277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 SETON DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-1873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-723-6365
Provider Business Practice Location Address Fax Number:
301-723-6277
Provider Enumeration Date:
12/08/2006

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:
301-723-1443

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001708660 . This is a "MT. STATE BC BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7741413-01 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 774141304 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: G362 . This is a "FEDERAL BC BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: K936SE . This is a "BC BS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 774141303 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA5993 CH3960 CE790 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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