Provider Demographics
NPI:1417107913
Name:GREATER BADEN MEDICAL SERVICE INCORPORATED
Entity Type:Organization
Organization Name:GREATER BADEN MEDICAL SERVICE INCORPORATED
Other - Org Name:GREATER BADEN MEDICAL SERVICE AT LA PLATA
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KURCAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-599-2172
Mailing Address - Street 1:7450 ALBERT RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3035
Mailing Address - Country:US
Mailing Address - Phone:308-882-2233
Mailing Address - Fax:
Practice Address - Street 1:6 GARRETT AVE
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5959
Practice Address - Country:US
Practice Address - Phone:301-539-5100
Practice Address - Fax:301-934-2084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER BADEN MEDICAL SERVICE INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-22
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD911431900Medicaid
MD211818Medicare PIN