Provider Demographics
NPI:1942875026
Name:OWENSVILLE PRIMARY CARE,INC
Entity Type:Organization
Organization Name:OWENSVILLE PRIMARY CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:VARGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-353-1513
Mailing Address - Street 1:134 OWENSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20778-9702
Mailing Address - Country:US
Mailing Address - Phone:410-867-4700
Mailing Address - Fax:410-867-4934
Practice Address - Street 1:5408 SOUTHERN MARYLAND BLVD
Practice Address - Street 2:
Practice Address - City:LOTHIAN
Practice Address - State:MD
Practice Address - Zip Code:20711-2601
Practice Address - Country:US
Practice Address - Phone:410-867-4700
Practice Address - Fax:410-867-4934
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1225110067
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)