| South Mountain Family Practice Llc | |
|
9 Saint Paul St Boonsboro MD 21713-1334 | |
| (301) 432-0623 | |
| (301) 432-0624 |
| Full Name | South Mountain Family Practice Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9 Saint Paul St, Boonsboro, Maryland |
| Authorized Official Name and Position | William F Bodenheimer (OWNER) |
| Authorized Official Contact | 3014320623 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Mountain Family Practice Llc 9 Saint Paul St Boonsboro MD 21713-1334 Ph: (301) 432-0623 | South Mountain Family Practice Llc 9 Saint Paul St Boonsboro MD 21713-1334 Ph: (301) 432-0623 |
| NPI Number | 1487844593 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 06/29/2011 |
| Medicare PECOS PAC ID | 6406813971 |
|---|---|
| Medicare Enrollment ID | O20041216000151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487844593 | NPI | - | NPPES |
| 864001700 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | D0056826 (Maryland) | Primary |
| Provider Name | William Bodenheimer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427010354 PECOS PAC ID: 7113984691 Enrollment ID: I20041216000198 |
Pleasant Valley Primary Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 20311 Lappans Rd Ste 100, Boonsboro, MD 21713 Phone: 301-573-9453 |