| Park West Health Systems Incorporated | |
|
4151 Park Heights Ave Baltimore MD 21215-6730 | |
| (443) 874-5502 | |
| (443) 836-0405 |
| Full Name | Park West Health Systems Incorporated |
|---|---|
| Speciality | Clinic/Center |
| Location | 4151 Park Heights Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Terri Mitchell (CREDENTIALING) |
| Authorized Official Contact | 4105427800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park West Health Systems Incorporated 3319 W Belvedere Ave Baltimore MD 21215-5103 Ph: (410) 542-7800 | Park West Health Systems Incorporated 4151 Park Heights Ave Baltimore MD 21215-6730 Ph: (443) 874-5502 |
| NPI Number | 1255512638 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 05/25/2011 |
| Medicare PECOS PAC ID | 8921090820 |
|---|---|
| Medicare Enrollment ID | O20080310000489 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255512638 | 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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