| Mountain Laurel Medical Center | |
|
22221 Westernport Rd Sw Westernport MD 21562-2206 | |
| (240) 774-0204 | |
| (301) 533-3299 |
| Full Name | Mountain Laurel Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 22221 Westernport Rd Sw, Westernport, Maryland |
| Authorized Official Name and Position | Brian G Bailey (CEO) |
| Authorized Official Contact | 3015333300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Laurel Medical Center 1027 Memorial Dr Oakland MD 21550-4343 Ph: (301) 533-3300 | Mountain Laurel Medical Center 22221 Westernport Rd Sw Westernport MD 21562-2206 Ph: (240) 774-0204 |
| NPI Number | 1265906994 |
|---|---|
| Provider Enumeration Date | 01/16/2019 |
| Last Update Date | 10/09/2020 |
| Medicare PECOS PAC ID | 9436152493 |
|---|---|
| Medicare Enrollment ID | O20190626003165 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265906994 | NPI | - | NPPES |
| 3810007182 | Medicaid | WV | |
| 1030070260002 | Medicaid | PA | |
| 7118 | Other | MD | CAREFIRST BC/BS |
| 410467600 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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