Provider Demographics
NPI:1912976796
Name:PEOPLES COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:PEOPLES COMMUNITY HEALTH CENTER, INC
Other - Org Name:PIONEER CITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSATT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:410-235-8801
Mailing Address - Street 1:2204 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5625
Mailing Address - Country:US
Mailing Address - Phone:410-467-6040
Mailing Address - Fax:
Practice Address - Street 1:8341 PIONEER DRIVE
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144
Practice Address - Country:US
Practice Address - Phone:410-467-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD910561100Medicaid
MDH649OtherBLUE CROSS BLUE SHIELD
MDH649Medicare PIN
MD910561100Medicaid