| |
1000 E Eager St Baltimore MD 21202-5533 | |
(410) 522-9800 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1000 E Eager St, Baltimore, Maryland |
Authorized Official Name and Position | Shirley Sutton (PRESIDENT/CEO) |
Authorized Official Contact | 4105584891 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5525 Eastern Ave Ste 301 Baltimore MD 21224-2796 Ph: (410) 558-4890 | 1000 E Eager St Baltimore MD 21202-5533 Ph: (410) 522-9800 |
NPI Number | 1396366308 |
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Provider Enumeration Date | 04/30/2020 |
Last Update Date | 02/02/2024 |
Medicare PECOS PAC ID | 5395653455 |
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Medicare Enrollment ID | O20200514000823 |
Identifier | Type | State | Issuer |
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1396366308 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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