Provider Demographics
NPI:1053086421
Name:CHOPTANK COMMUNITY HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:CHOPTANK COMMUNITY HEALTH SYSTEM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-479-4306
Mailing Address - Street 1:627 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21639-1469
Mailing Address - Country:US
Mailing Address - Phone:410-482-9148
Mailing Address - Fax:833-914-0405
Practice Address - Street 1:627 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:MD
Practice Address - Zip Code:21639-1469
Practice Address - Country:US
Practice Address - Phone:410-482-9148
Practice Address - Fax:833-914-0405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOPTANK COMMUNITY HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)