1417107913 NPI number — GREATER BADEN MEDICAL SERVICE INCORPORATED

Table of content: (NPI 1417107913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417107913 NPI number — GREATER BADEN MEDICAL SERVICE INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER BADEN MEDICAL SERVICE INCORPORATED
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:
1417107913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7450 ALBERT RD FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDYWINE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20613-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-882-2233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 GARRETT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PLATA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20646-5959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-539-5100
Provider Business Practice Location Address Fax Number:
301-934-2084
Provider Enumeration Date:
09/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KURCAB
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
301-599-2172

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 911431900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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