Provider Demographics
NPI:1649207168
Name:ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC.
Entity Type:Organization
Organization Name:ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC.
Other - Org Name:NORTH COUNTY EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRAAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-475-6003
Mailing Address - Street 1:P.O. BOX 527
Mailing Address - Street 2:25500 POINT LOOKOUT ROAD
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650
Mailing Address - Country:US
Mailing Address - Phone:301-475-6044
Mailing Address - Fax:410-882-3310
Practice Address - Street 1:37767 MARKET DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622
Practice Address - Country:US
Practice Address - Phone:301-290-1499
Practice Address - Fax:410-882-3310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-28
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD537LMedicare PIN