Provider Demographics
NPI:1356341499
Name:GARRETT COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:GARRETT COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:301-533-4000
Mailing Address - Street 1:251 N FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1375
Mailing Address - Country:US
Mailing Address - Phone:301-533-4201
Mailing Address - Fax:301-533-4208
Practice Address - Street 1:251 N FOURTH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1375
Practice Address - Country:US
Practice Address - Phone:301-533-4201
Practice Address - Fax:301-533-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11-002282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
59023801OtherCAREFIRST BCBS
59023801OtherBLUE CROSS
MD000245300Medicaid
0006310435OtherAETNA
59023801OtherB/C CONSOL
59023801OtherB/C NATIONAL
MA6OtherB/C FEDERAL
59023801OtherTRIGON
59023801OtherB/C MOUNTAIN STATE
59023801OtherB/C GENERAL MOTORS
MA6OtherB/C EMPIRE
WVMA6OtherBC/WV
59023801OtherB/C VA POWER
59023801OtherB/C MD
59023801OtherHIGHMARK BC/BS
59023801OtherB/C OTHER
MA6OtherB/C MT STATE PEIA
MA6OtherB/C EMPIRE
MA6OtherB/C FEDERAL
MD000245300Medicaid