Provider Demographics
NPI:1669934972
Name:THE CHARLES COUNTY MOBILE INTENSIVE CARE UNIT INC
Entity type:Organization
Organization Name:THE CHARLES COUNTY MOBILE INTENSIVE CARE UNIT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-479-4790
Mailing Address - Street 1:400 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1041
Mailing Address - Country:US
Mailing Address - Phone:410-479-4790
Mailing Address - Fax:410-479-4793
Practice Address - Street 1:10700 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3075
Practice Address - Country:US
Practice Address - Phone:301-638-3915
Practice Address - Fax:410-479-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance