Provider Demographics
NPI:1407357288
Name:GIFTIE MEDICAL SERVICES
Entity Type:Organization
Organization Name:GIFTIE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEJANGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-605-5582
Mailing Address - Street 1:23304 RAINBOW ARCH DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4449
Mailing Address - Country:US
Mailing Address - Phone:240-605-5582
Mailing Address - Fax:301-972-1768
Practice Address - Street 1:23304 RAINBOW ARCH DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4449
Practice Address - Country:US
Practice Address - Phone:240-605-5582
Practice Address - Fax:301-972-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4162251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD621610OtherBUSINESS CODE #
MDW17252651OtherTAX ID #