Provider Demographics
NPI:1821233487
Name:SPRING FAMILY MEDICAL CENTER P.C.
Entity Type:Organization
Organization Name:SPRING FAMILY MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:MOSES
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-562-7764
Mailing Address - Street 1:1111 SPRING ST
Mailing Address - Street 2:SUIT G1
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4003
Mailing Address - Country:US
Mailing Address - Phone:301-562-7764
Mailing Address - Fax:301-562-0884
Practice Address - Street 1:1111 SPRING ST
Practice Address - Street 2:SUIT G1
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4003
Practice Address - Country:US
Practice Address - Phone:301-562-7764
Practice Address - Fax:301-562-0884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRING FAMILY MEDICAL CENTER P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-11
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD52883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty