Provider Demographics
NPI:1629700604
Name:FREDERICK HEALTH MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:FREDERICK HEALTH MEDICAL GROUP LLC
Other - Org Name:FREDERICK HEALTH URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-439-8812
Mailing Address - Street 1:400 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16403 OLD EMMITSBURG RD
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-8929
Practice Address - Country:US
Practice Address - Phone:240-215-6310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care