Provider Demographics
NPI:1003553272
Name:1ST STEP MEDICAL & 1ST STEP GREENMED, LLC
Entity Type:Organization
Organization Name:1ST STEP MEDICAL & 1ST STEP GREENMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:410-582-8170
Mailing Address - Street 1:PO BOX 1538
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-1538
Mailing Address - Country:US
Mailing Address - Phone:410-582-8170
Mailing Address - Fax:866-401-0775
Practice Address - Street 1:420 CRAIN HWY S STE 2
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3657
Practice Address - Country:US
Practice Address - Phone:410-582-8170
Practice Address - Fax:866-401-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center