1982809760 NPI number — FAMILY TRAUMA SERVICES, INC.

Table of content: (NPI 1982809760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982809760 NPI number — FAMILY TRAUMA SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY TRAUMA SERVICES, 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:
1982809760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2065
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20847-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-306-6306
Provider Business Mailing Address Fax Number:
301-306-6306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9470 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-306-6306
Provider Business Practice Location Address Fax Number:
301-306-6304
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARKS
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
301-306-6306

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , 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: 521170101 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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