| |
9030 State Route 108 Ste A Columbia MD 21045-1990 | |
(410) 740-1901 | |
(410) 740-8932 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 9030 State Route 108 Ste A, Columbia, Maryland |
Authorized Official Name and Position | Sue Kessler (DIRECTOR, REVENUE CYCLE) |
Authorized Official Contact | 4103828111 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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230 W Patrick St Frederick MD 21701-6945 Ph: (301) 662-0099 | 9030 State Route 108 Ste A Columbia MD 21045-1990 Ph: (410) 740-1901 |
NPI Number | 1104914464 |
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Provider Enumeration Date | 10/11/2006 |
Last Update Date | 05/05/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104914464 | NPI | - | NPPES |
K011WA | Other | MD | MDBCBS GROUP NUMBER |
T806 | Other | MD | BLUE CHOICE GROUP NUMBER |
264161501 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Ethos Health Maryland 3 Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10840 Little Patuxent Pkwy, Columbia, MD 21044 Phone: 352-732-5590 Fax: 352-732-0292 | |
Lorien Dialysis, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6334 Cedar Ln, Columbia, MD 21044 Phone: 410-750-7500 | |
Premier Medical Group Of Maryland Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10705 Charter Dr Ste 420, Columbia, MD 21044 Phone: 410-709-7432 | |
University Of Maryland Physicians, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5890 Waterloo Rd, Columbia, MD 21045 Phone: 410-667-2142 Fax: 410-799-9097 | |