Provider Demographics
NPI:1881849255
Name:KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INC
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INC
Other - Org Name:FREDERICKSBURG MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANDEE
Authorized Official - Middle Name:G
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, MBA
Authorized Official - Phone:301-816-5760
Mailing Address - Street 1:2101 EAST JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE DATA MANAGEMT DEPT.ATTN:SANJAY MATHUR
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-7446
Mailing Address - Fax:301-816-7170
Practice Address - Street 1:1201 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8428
Practice Address - Country:US
Practice Address - Phone:540-368-3700
Practice Address - Fax:301-816-7170
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-26
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08232OtherMEDICARE GROUP ID