Provider Demographics
NPI:1689985194
Name:CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Other - Org Name:ST. MICHAEL'S ELEMENTARY SCHOOL SBHC
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 1:100 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2930
Mailing Address - Country:US
Mailing Address - Phone:410-745-2882
Mailing Address - Fax:410-479-1714
Practice Address - Street 1:100 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:ST. MICHAEL'S
Practice Address - State:MD
Practice Address - Zip Code:21663-2930
Practice Address - Country:US
Practice Address - Phone:410-745-2882
Practice Address - Fax:410-479-1714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD784381000Medicaid