Provider Demographics
NPI:1922582782
Name:PUGH'S PATIENT CARE SERVICES
Entity Type:Organization
Organization Name:PUGH'S PATIENT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER-PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-944-7515
Mailing Address - Street 1:11793 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-1240
Mailing Address - Country:US
Mailing Address - Phone:410-621-5701
Mailing Address - Fax:443-888-6317
Practice Address - Street 1:11793 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1240
Practice Address - Country:US
Practice Address - Phone:410-621-5701
Practice Address - Fax:443-888-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicaid