Provider Demographics
NPI:1710755392
Name:ST MARYS COLLEGE OF MARYLAND HEALTH SERVICES
Entity Type:Organization
Organization Name:ST MARYS COLLEGE OF MARYLAND HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINCE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-895-4289
Mailing Address - Street 1:47665 MARGARET BRENT WAY
Mailing Address - Street 2:
Mailing Address - City:ST MARY'S CITY
Mailing Address - State:MD
Mailing Address - Zip Code:20630
Mailing Address - Country:US
Mailing Address - Phone:240-895-4289
Mailing Address - Fax:240-895-4937
Practice Address - Street 1:47665 MARGARET BRENT WAY
Practice Address - Street 2:
Practice Address - City:ST MARY'S CITY
Practice Address - State:MD
Practice Address - Zip Code:20630
Practice Address - Country:US
Practice Address - Phone:240-895-4289
Practice Address - Fax:240-895-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service