Provider Demographics
NPI:1871252767
Name:MISO MEDICAL CENTER
Entity Type:Organization
Organization Name:MISO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ONYIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-918-3829
Mailing Address - Street 1:14440 CHERRY LANE CT STE 218
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4946
Mailing Address - Country:US
Mailing Address - Phone:240-918-3829
Mailing Address - Fax:301-567-7399
Practice Address - Street 1:14440 CHERRY LANE CT STE 218
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4946
Practice Address - Country:US
Practice Address - Phone:240-918-3829
Practice Address - Fax:301-567-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty