1881683423 NPI number — MCCREADY FOUNDATION, INC

Table of content: (NPI 1881683423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881683423 NPI number — MCCREADY FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCREADY FOUNDATION, 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:
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:
1881683423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 HALL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRISFIELD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21817-1237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-968-1200
Provider Business Mailing Address Fax Number:
410-968-1025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 HALL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRISFIELD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21817-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-968-1200
Provider Business Practice Location Address Fax Number:
410-968-1025
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
410-968-1200

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QA1903X , with the licence number: 19-001 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 282N00000X , with the licence number: 19-001 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 131292 . This is a "PRIORITY PARTNERS CLINIC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 110988 . This is a "PRIORITY PARTNERS ANESTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 49827 . This is a "AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 059693 . This is a "PRIORITY PARTNERS OT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 235089 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 236781500 , issued by the state of ( MH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9805516 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000285200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5000064 . This is a "UNITED HEALTH CARE MCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0126401 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1059279 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57350401 . This is a "CAREFIRST BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: MC9 . This is a "BCBS NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000358106 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132748 . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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