Provider Demographics
NPI:1174019327
Name:OWENSVILLE PRIMARY CARE, INC
Entity Type:Organization
Organization Name:OWENSVILLE PRIMARY CARE, INC
Other - Org Name:BAY COMMUNITY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-867-4700
Mailing Address - Street 1:134 OWENSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20778-9702
Mailing Address - Country:US
Mailing Address - Phone:410-867-4700
Mailing Address - Fax:410-867-4934
Practice Address - Street 1:6131 SHADY SIDE RD
Practice Address - Street 2:
Practice Address - City:SHADY SIDE
Practice Address - State:MD
Practice Address - Zip Code:20764-9504
Practice Address - Country:US
Practice Address - Phone:410-867-2200
Practice Address - Fax:410-867-1261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1225110067
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-10
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0431103TB0200X
MDH78924207Q00000X
207Q00000X, 261QF0400X
MDD0038563207R00000X
MDH00764072083P0901X
MDC0003844363A00000X
MDR124971363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400629100Medicaid
MD531981100Medicaid
MD209002300Medicaid
MD338427600Medicaid
MD103559201Medicaid
MD404482700Medicaid
MD97991100Medicaid