Provider Demographics
NPI:1225110067
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 ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20778-9998
Mailing Address - Country:US
Mailing Address - Phone:410-867-1268
Mailing Address - Fax:410-867-8754
Practice Address - Street 1:134 OWENSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST RIVER
Practice Address - State:MD
Practice Address - Zip Code:20778-9998
Practice Address - Country:US
Practice Address - Phone:410-867-1268
Practice Address - Fax:410-867-8754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404482700Medicaid
MD404482700Medicaid