Provider Demographics
NPI:1255030136
Name:PROSPERITY MEDICAL AND HEALTH SYSTEMS, LLC
Entity type:Organization
Organization Name:PROSPERITY MEDICAL AND HEALTH SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-837-8493
Mailing Address - Street 1:13922 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5009
Mailing Address - Country:US
Mailing Address - Phone:443-791-7005
Mailing Address - Fax:
Practice Address - Street 1:13922 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5009
Practice Address - Country:US
Practice Address - Phone:443-791-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center