| Park West Health System Incorporated | |
|
4120 Patterson Ave Baltimore MD 21215-2254 | |
| (410) 542-7800 | |
| (410) 542-5279 |
| Full Name | Park West Health System Incorporated |
|---|---|
| Speciality | Clinic/Center |
| Location | 4120 Patterson Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Terri Fields (CREDENTIALING) |
| Authorized Official Contact | 4435676120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park West Health System Incorporated 3319 W Belvedere Ave Baltimore MD 21215-5103 Ph: (410) 542-7800 | Park West Health System Incorporated 4120 Patterson Ave Baltimore MD 21215-2254 Ph: (410) 542-7800 |
| NPI Number | 1497801153 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 06/24/2024 |
| Medicare PECOS PAC ID | 8921090820 |
|---|---|
| Medicare Enrollment ID | O20120210000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497801153 | NPI | - | NPPES |
| 912391100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Maryland) | Primary |
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