1730479080 NPI number — NORTHWEST HOSPITAL CENTER INC

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 1730479080 NPI number — NORTHWEST HOSPITAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST HOSPITAL CENTER 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:
THE LIFEBRIDGE PHARMACY AT NORTHWEST HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1730479080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 OLD COURT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANDALLSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21133-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-701-4455
Provider Business Mailing Address Fax Number:
410-701-4422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 OLD COURT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANDALLSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21133-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-701-4455
Provider Business Practice Location Address Fax Number:
410-701-4422
Provider Enumeration Date:
04/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMICK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
AVP
Authorized Official Telephone Number:
410-701-4618

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P05509 , 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: 2130052 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 418994000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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