Provider Demographics
NPI:1609007095
Name:ADVENTIST PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:ADVENTIST PHYSICIAN SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-315-3826
Mailing Address - Street 1:820 WEST DIAMOND AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-315-3826
Mailing Address - Fax:301-315-3728
Practice Address - Street 1:9909 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:240-864-6007
Practice Address - Fax:240-864-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02382Medicare PIN