N/a | |
3512 Sandpiper Ct Edgewood MD 21040-3736 | |
(443) 866-7504 | |
Not Available |
Full Name | N/a |
---|---|
Speciality | Community/Behavioral Health |
Location | 3512 Sandpiper Ct, Edgewood, Maryland |
Authorized Official Name and Position | Quinton Myers (CEO) |
Authorized Official Contact | 4438667504 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
N/a 3512 Sandpiper Ct Edgewood MD 21040-3736 Ph: (443) 866-7504 | N/a 3512 Sandpiper Ct Edgewood MD 21040-3736 Ph: (443) 866-7504 |
NPI Number | 1386181311 |
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Provider Enumeration Date | 01/29/2017 |
Last Update Date | 01/29/2017 |
Medicare PECOS PAC ID | 7911284419 |
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Medicare Enrollment ID | O20170511000332 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386181311 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 5000000000741693 (Maryland) | Primary |
Provider Name | Quinton G Myers |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528411725 PECOS PAC ID: 4385922699 Enrollment ID: I20161020001284 |
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