Provider Demographics
NPI:1265819866
Name:SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
Entity Type:Organization
Organization Name:SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
Other - Org Name:SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-533-4000
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:880 MEMORIAL DR
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-5101
Practice Address - Country:US
Practice Address - Phone:301-334-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty