Provider Demographics
NPI: | 1306408612 |
---|---|
Name: | ATLANTIC GENERAL HOSPITAL CORPORATION |
Entity Type: | Organization |
Organization Name: | ATLANTIC GENERAL HOSPITAL CORPORATION |
Other - Org Name: | AGHS BEHAVORIAL |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | VP FINANCE/CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHERYL |
Authorized Official - Middle Name: | LEWIS |
Authorized Official - Last Name: | NOTTINGHAM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 410-641-9602 |
Mailing Address - Street 1: | 10026 OLD OCEAN CITY BLVD, BLDG 1 |
Mailing Address - Street 2: | AGHS PHYSICIAN BILLING OFFICE |
Mailing Address - City: | BERLIN |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21811 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-629-6007 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 9714 HEALTHWAY DR |
Practice Address - Street 2: | |
Practice Address - City: | BERLIN |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21811-1154 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-641-3340 |
Practice Address - Fax: | 410-641-3341 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-07-08 |
Last Update Date: | 2022-04-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Single Specialty |
No | 2080P0008X | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities | Group - Single Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Single Specialty |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | Group - Single Specialty |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Single Specialty |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
No | 261QP3300X | Ambulatory Health Care Facilities | Clinic/Center | Pain | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 514300400 | Medicaid |