| Ccs Rockville - Medicaid (facility) | |
|
199 E Montgomery Ave Ste 100 Rockville MD 20850-2361 | |
| (410) 740-8066 | |
| (410) 740-8068 |
| Full Name | Ccs Rockville - Medicaid (facility) |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 199 E Montgomery Ave Ste 100, Rockville, Maryland |
| Authorized Official Name and Position | Mark David Donovan (CEO) |
| Authorized Official Contact | 4107408066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccs Rockville - Medicaid (facility) 10630 Little Patuxent Pkwy Ste 209 Columbia MD 21044-6278 Ph: (410) 740-8066 | Ccs Rockville - Medicaid (facility) 199 E Montgomery Ave Ste 100 Rockville MD 20850-2361 Ph: (410) 740-8066 |
| NPI Number | 1194318196 |
|---|---|
| Provider Enumeration Date | 02/19/2021 |
| Last Update Date | 10/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194318196 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
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