Provider Demographics
NPI:1659396851
Name:MERITUS MEDICAL CENTER INC
Entity Type:Organization
Organization Name:MERITUS MEDICAL CENTER INC
Other - Org Name:MERITUS BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:REPAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-790-9351
Mailing Address - Street 1:11116 MEDICAL CAMPUS RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6710
Mailing Address - Country:US
Mailing Address - Phone:301-797-2000
Mailing Address - Fax:301-797-9480
Practice Address - Street 1:11116 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 2989
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6710
Practice Address - Country:US
Practice Address - Phone:301-766-7600
Practice Address - Fax:301-797-9480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERITUS MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21-012261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK025OtherBLUECROSS-MARYLAND
MD794060200Medicaid
MDW767OtherBLUECROSS-FEP/GHMSI
MDK025Medicare ID - Type UnspecifiedMEDICARE PART B