Provider Demographics
NPI:1922244581
Name:TOTAL IMAGE CARE, INC.
Entity Type:Organization
Organization Name:TOTAL IMAGE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:410-560-0614
Mailing Address - Street 1:800 ARMY RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6701
Mailing Address - Country:US
Mailing Address - Phone:410-560-0614
Mailing Address - Fax:410-560-0613
Practice Address - Street 1:601 N BROADWAY ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-502-5623
Practice Address - Fax:410-502-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMH24OtherCAREFIRST BCBS
MD6010008Medicaid
DCF807OtherCAREFIRST BCBS
1146880003Medicare NSC