Provider Demographics
NPI:1619658333
Name:REMEDIUM ANCILLARY SERVICES
Entity Type:Organization
Organization Name:REMEDIUM ANCILLARY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:PRINCE
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-240-7072
Mailing Address - Street 1:10203 GRANDHAVEN AVE # 115
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6656
Mailing Address - Country:US
Mailing Address - Phone:443-240-7072
Mailing Address - Fax:
Practice Address - Street 1:10203 GRANDHAVEN AVE # 115
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6656
Practice Address - Country:US
Practice Address - Phone:443-240-7072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No167G00000XNursing Service ProvidersLicensed Psychiatric TechnicianGroup - Multi-Specialty