Provider Demographics
NPI: | 1629743034 |
---|---|
Name: | 1ST MEDICAL PAIN MANAGEMENT SPECIALISTS |
Entity Type: | Organization |
Organization Name: | 1ST MEDICAL PAIN MANAGEMENT SPECIALISTS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROSEMARY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | INGADO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHYSICIAN ASSISTANT |
Authorized Official - Phone: | 410-956-6800 |
Mailing Address - Street 1: | 831 UNIVERSITY BLVD E STE 34 |
Mailing Address - Street 2: | |
Mailing Address - City: | SILVER SPRING |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20903-2915 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-408-2720 |
Mailing Address - Fax: | 301-408-4503 |
Practice Address - Street 1: | 831 UNIVERSITY BLVD E STE 34 |
Practice Address - Street 2: | |
Practice Address - City: | SILVER SPRING |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20903-2915 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-408-2720 |
Practice Address - Fax: | 301-408-2725 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | 1ST MEDICAL OF ANNAPOLIS, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2021-08-09 |
Last Update Date: | 2022-01-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 225C00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Group - Multi-Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |