| Port Recovery Physicians Care Llc | |
|
8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 | |
| (443) 869-4909 | |
| (443) 869-4928 |
| Full Name | Port Recovery Physicians Care Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8615 Ridgelys Choice Dr Ste 205, Nottingham, Maryland |
| Authorized Official Name and Position | Joanne Granruth (OWNER) |
| Authorized Official Contact | 4105348735 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Recovery Physicians Care Llc 8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 Ph: (443) 534-8735 | Port Recovery Physicians Care Llc 8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 Ph: (443) 869-4909 |
| NPI Number | 1124470356 |
|---|---|
| Provider Enumeration Date | 07/12/2016 |
| Last Update Date | 11/15/2018 |
| Medicare PECOS PAC ID | 8123307865 |
|---|---|
| Medicare Enrollment ID | O20161121000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124470356 | NPI | - | NPPES |
| 886200100 | Medicaid | MD | |
| CP64-0000 | Other | MD | CAREFIRST BLUECROSS BLUESHEILD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Randal Alan Steele |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811969835 PECOS PAC ID: 0749311892 Enrollment ID: I20110406000830 |
| Provider Name | Terri S Nicholson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144659400 PECOS PAC ID: 8426287350 Enrollment ID: I20140218001576 |
| Provider Name | Elaine Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174504047 PECOS PAC ID: 9032115167 Enrollment ID: I20140728000166 |
| Provider Name | Belinda K Hester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972943322 PECOS PAC ID: 8921226671 Enrollment ID: I20140821002576 |
Jeffrey C. Schultz, M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8817 Belair Rd, Suite 111, Nottingham, MD 21236 Phone: 410-529-6440 Fax: 410-529-6793 | |
Ethos Health Maryland 1 Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4940 Campbell Blvd Ste 130, Nottingham, MD 21236 Phone: 410-870-6498 Fax: 410-870-6555 | |
Sofia Suriel Md Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8870 Belair Rd, Nottingham, MD 21236 Phone: 410-248-3124 Fax: 410-248-3125 | |
Lifegate Global Health Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5430 Campbell Blvd, Ste 208, Nottingham, MD 21236 Phone: 443-823-5066 | |
Maryland Medical Center, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8100 Sandpiper Cir Ste 100, Nottingham, MD 21236 Phone: 410-529-8334 | |
Breakthrough Integrative Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9712 Belair Rd Ste 301, Nottingham, MD 21236 Phone: 443-903-4874 Fax: 667-868-0931 |