Provider Demographics
NPI:1770578080
Name:SIGNATURE HEALTHCARE INC.
Entity type:Organization
Organization Name:SIGNATURE HEALTHCARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-771-0404
Mailing Address - Street 1:10943 MCCORMICK RD
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1401
Mailing Address - Country:US
Mailing Address - Phone:410-771-0404
Mailing Address - Fax:410-771-0010
Practice Address - Street 1:10943 MCCORMICK RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1401
Practice Address - Country:US
Practice Address - Phone:410-771-0404
Practice Address - Fax:410-771-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1076332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA211310OtherBCBS HIGHMARK PA PROV #
MD80709OtherNORTHWOOD NPN PROV #
MD009440400Medicaid
MDMH61OtherCAREFIRST BCBS MD PROV #
MDF6050001OtherCAREFIRST FEDERAL PROV #
MD60412702OtherCAREFIRST BCBS MD PROV #
MD94996OtherAMERICAID PROVIDER NUMBER
MD1220070001Medicare NSC