Provider Demographics
NPI:1851010771
Name:GREATER BADEN MEDICAL SERVICE INCORPORATED
Entity Type:Organization
Organization Name:GREATER BADEN MEDICAL SERVICE INCORPORATED
Other - Org Name:GREATER BADEN MEDICAL SERVICE AT LEXINGTON PARK
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KURCAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-599-2172
Mailing Address - Street 1:7450 ALBERT RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3035
Mailing Address - Country:US
Mailing Address - Phone:301-888-3322
Mailing Address - Fax:
Practice Address - Street 1:21625 GREAT MILLS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1239
Practice Address - Country:US
Practice Address - Phone:301-637-8331
Practice Address - Fax:301-637-6625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER BADEN MEDICAL SERVICE INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-24
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD911431900Medicaid