Provider Demographics
NPI:1679790299
Name:CHOPTANK COMMUNITY HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:CHOPTANK COMMUNITY HEALTH SYSTEM INC
Other - Org Name:BAY HUNDRED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-479-4306
Mailing Address - Street 1:933 S TALBOT ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2605
Mailing Address - Country:US
Mailing Address - Phone:410-745-0200
Mailing Address - Fax:339-082-2818
Practice Address - Street 1:933 S TALBOT ST
Practice Address - Street 2:UNIT 4
Practice Address - City:ST MICHAELS
Practice Address - State:MD
Practice Address - Zip Code:21663-2633
Practice Address - Country:US
Practice Address - Phone:410-745-0200
Practice Address - Fax:833-908-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211830Medicare Oscar/Certification