| Park West Health System, Inc. | |
|
4601 Liberty Heights Ave Baltimore MD 21207-7553 | |
| (443) 884-7577 | |
| (667) 239-3121 |
| Full Name | Park West Health System, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 4601 Liberty Heights Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Elizabeth Lee (CFO) |
| Authorized Official Contact | 4105427800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park West Health System, Inc. 4601 Liberty Heights Ave Baltimore MD 21207-7553 Ph: (410) 542-7800 | Park West Health System, Inc. 4601 Liberty Heights Ave Baltimore MD 21207-7553 Ph: (443) 884-7577 |
| NPI Number | 1073914206 |
|---|---|
| Provider Enumeration Date | 09/08/2014 |
| Last Update Date | 11/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073914206 | NPI | - | NPPES |
| 912391100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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