1558405266 NPI number — WESTERN MARYLAND HEALTH SYSTEM BRADDOCK HOSPITAL CORPORATION

Table of content: (NPI 1558405266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558405266 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:
1558405266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 SETON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-1854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-964-8342
Provider Business Mailing Address Fax Number:
240-964-8337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SETON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-1854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-964-8342
Provider Business Practice Location Address Fax Number:
240-964-8337
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REPAC
Authorized Official First Name:
KIMBERLEY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SR VP CFO
Authorized Official Telephone Number:
240-964-8342

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 61636306 . This is a "CAREFIRST CENTRE ST LAB" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W474SA . This is a "FHC CAREFIRST GRP." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 61636304 . This is a "CAREFIRST FHC LAB" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 62018801 KFA5SA . This is a "CAREFIRST FHC X-RAY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: H857 0001 . This is a "BLUE CHOICE LABORATORY" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: H856 0001 . This is a "BLUE CHOICE X-RAY FHC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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