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2401 Liberty Heights Ave Ste 111-113 Baltimore MD 21215-8019 | |
(410) 383-8300 | |
(410) 383-3160 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2401 Liberty Heights Ave Ste 111-113, Baltimore, Maryland |
Authorized Official Name and Position | Kevin D Bellamy (CEO) |
Authorized Official Contact | 4107284090 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1501 Division St Baltimore MD 21217-3121 Ph: (410) 383-8300 | 2401 Liberty Heights Ave Ste 111-113 Baltimore MD 21215-8019 Ph: (410) 383-8300 |
NPI Number | 1013902485 |
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Provider Enumeration Date | 09/13/2005 |
Last Update Date | 10/17/2024 |
Medicare PECOS PAC ID | 0446258487 |
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Medicare Enrollment ID | O20070203000121 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013902485 | NPI | - | NPPES |
905611400 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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