Provider Demographics
NPI:1346341716
Name:WESTERN MARYLAND HEALTH SYSTEM CORPORATION
Entity Type:Organization
Organization Name:WESTERN MARYLAND HEALTH SYSTEM CORPORATION
Other - Org Name:WMHS URGENT CARE SERVICES - HUNT CLUB MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:REPAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-964-8003
Mailing Address - Street 1:45 HUNT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-7567
Mailing Address - Country:US
Mailing Address - Phone:304-726-4501
Mailing Address - Fax:304-726-4051
Practice Address - Street 1:45 HUNT CLUB DR
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-7567
Practice Address - Country:US
Practice Address - Phone:304-726-4501
Practice Address - Fax:304-726-4051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN MARYLAND HEALTH SYSTEM CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002358Medicaid
WV001304838OtherMT. STATE BC BS
MDA05 LU39HUOtherCAREFIRST BC BS MARYLAND
DCE458OtherDC BC BS - BLUE CHOICE
MDCN1324OtherRAILROAD MEDICARE