| Adullum Community Healthcare Center, Inc. | |
|
644 E 33rd St Baltimore MD 21218-3504 | |
| (318) 348-5622 | |
| Not Available |
| Full Name | Adullum Community Healthcare Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 644 E 33rd St, Baltimore, Maryland |
| Authorized Official Name and Position | Irance Reddix (CEO/MEDICAL DIRECTOR) |
| Authorized Official Contact | 3183485622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adullum Community Healthcare Center, Inc. 3317 Kenjac Rd Windsor Mill MD 21244-1323 Ph: (318) 348-5622 | Adullum Community Healthcare Center, Inc. 644 E 33rd St Baltimore MD 21218-3504 Ph: (318) 348-5622 |
| NPI Number | 1801277520 |
|---|---|
| Provider Enumeration Date | 06/18/2015 |
| Last Update Date | 05/13/2022 |
| Medicare PECOS PAC ID | 4789974932 |
|---|---|
| Medicare Enrollment ID | O20160601000551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801277520 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Irance E Reddix |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659310431 PECOS PAC ID: 0042123630 Enrollment ID: I20071004000572 |
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