Provider Demographics
| NPI: | 1497161483 |
|---|---|
| Name: | CHASE BREXTON HEALTH SERVICES INC |
| Entity Type: | Organization |
| Organization Name: | CHASE BREXTON HEALTH SERVICES INC |
| Other - Org Name: | CHASE BREXTON HEALTH CARE |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | REVENUE CYCLE DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KYLE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | EASTON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 410-837-2050 |
| Mailing Address - Street 1: | 1111 N CHARLES ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BALTIMORE |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21201-5505 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 410-837-2050 |
| Mailing Address - Fax: | 410-752-1374 |
| Practice Address - Street 1: | 200 HOSPITAL DRIVE |
| Practice Address - Street 2: | SUITE 300 |
| Practice Address - City: | GLEN BURNIE |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21061-5877 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 410-837-2050 |
| Practice Address - Fax: | 410-761-3160 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2014-07-10 |
| Last Update Date: | 2022-03-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RA0401X | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
| No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MD | 132190106 | Medicaid | |
| K802 | Medicare UPIN | ||
| MD | 132190100 | Medicaid |
