Provider Demographics
NPI:1801879390
Name:BROADMEAD MEDICAL SERVICES, INC
Entity type:Organization
Organization Name:BROADMEAD MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING/ACCOUNTING DEPT.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:443-578-8043
Mailing Address - Street 1:13801 YORK RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1825
Mailing Address - Country:US
Mailing Address - Phone:410-527-1900
Mailing Address - Fax:410-527-3516
Practice Address - Street 1:13801 YORK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-1825
Practice Address - Country:US
Practice Address - Phone:410-527-1900
Practice Address - Fax:410-527-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6902000000OtherBLUECROSSBLUESHIELD
MD6902000000OtherBLUECROSSBLUESHIELD