| Providence Health Services, Inc | |
|
12200 Annapolis Rd Suite 118 Glenn Dale MD 20769-9182 | |
| (301) 464-9300 | |
| (202) 854-4093 |
| Full Name | Providence Health Services, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 12200 Annapolis Rd, Glenn Dale, Maryland |
| Authorized Official Name and Position | Charles F Haberkern (VP) |
| Authorized Official Contact | 2028544255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health Services, Inc 1160 Varnum St Ne St Catherine's Hall, Room 102 Washington DC 20017-2107 Ph: (202) 854-4069 | Providence Health Services, Inc 12200 Annapolis Rd Suite 118 Glenn Dale MD 20769-9182 Ph: (301) 464-9300 |
| NPI Number | 1962842401 |
|---|---|
| Provider Enumeration Date | 06/28/2013 |
| Last Update Date | 09/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962842401 | NPI | - | NPPES |
| 029833400 | Medicaid | DC | |
| 09810714 | Medicaid | VA | |
| 005145400 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | HFD01-0212 (District Of Columbia) | Primary |
| 282N00000X | General Acute Care Hospital | HFD01-0212 (District Of Columbia) | Secondary |
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Maryland Specialty Group Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12200 Annapolis Rd, Suite# 123, Glenn Dale, MD 20769 Phone: 301-552-9495 Fax: 301-552-9743 | |
Prime Medicine Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12150 Annapolis Rd, Suite 308, Glenn Dale, MD 20769 Phone: 301-805-0006 Fax: 301-805-5757 | |
Zenith Medical Care, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5808 Marietta Station Dr, Glenn Dale, MD 20769 Phone: 240-654-2389 Fax: 240-205-8617 | |
Krystal Medical Associates Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12150 Annapolis Rd, Suite 100, Glenn Dale, MD 20769 Phone: 301-464-7601 Fax: 866-885-9817 | |
Inclusive Health Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12200 Annapolis Rd Ste 316, Glenn Dale, MD 20769 Phone: 301-313-0600 Fax: 301-313-0603 | |
Maryland Family Healthcare, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12150 Annapolis Rd, Suite 212, Glenn Dale, MD 20769 Phone: 301-860-0002 Fax: 301-860-0504 |