| Open Gates Health Center | |
|
1111 Washington Blvd Baltimore MD 21230-1824 | |
| (410) 467-6040 | |
| (443) 743-2866 |
| Full Name | Open Gates Health Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1111 Washington Blvd, Baltimore, Maryland |
| Authorized Official Name and Position | Stacy Fruhling (CEO) |
| Authorized Official Contact | 4104676040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Open Gates Health Center Po Box 33109 Baltimore MD 21218-0401 Ph: (410) 467-6040 | Open Gates Health Center 1111 Washington Blvd Baltimore MD 21230-1824 Ph: (410) 467-6040 |
| NPI Number | 1154399228 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 06/02/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154399228 | NPI | - | NPPES |
| H649 | Other | MD | BLUE CROSS BLUE SHIELD |
| 910561100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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