Provider Demographics
NPI:1083720569
Name:AFFILIATED SANTE GROUP
Entity Type:Organization
Organization Name:AFFILIATED SANTE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-572-6585
Mailing Address - Street 1:12200 TECH RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1913
Mailing Address - Country:US
Mailing Address - Phone:301-572-6585
Mailing Address - Fax:
Practice Address - Street 1:1400 SPRING ST STE 100
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2751
Practice Address - Country:US
Practice Address - Phone:301-589-2303
Practice Address - Fax:301-585-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD352850200Medicaid
MD340671700Medicaid
MD3406717000Medicaid