Basic Information
| Provider Information | |||||||||
| NPI: | 1669567335 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNION HOSPITAL OF CECIL COUNTY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | PERRYVILLE DIAGNOSTIC CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 20 CRAIGTOWN RD | ||||||||
| Address2: | |||||||||
| City: | PORT DEPOSIT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219041801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103984000 | ||||||||
| FaxNumber: | 4106201493 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 CRAIGTOWN RD | ||||||||
| Address2: | |||||||||
| City: | PORT DEPOSIT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219041801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103984000 | ||||||||
| FaxNumber: | 4106201493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 02/08/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BEYER | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE CFO | ||||||||
| AuthorizedOfficialTelephone: | 4106202685 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 07005 | MD | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 407431900 | 05 | MD | MEDICAID | DDP7PE | 01 | MD | BC MD | OTHER | 0004568000 | 01 | MD | BLUE CROSS INDEPENDANCE | OTHER | 520607LAB | 01 | DE | BC DE OFF SITE LABS | OTHER | 520607RAD | 01 | DE | BC DE OFF SITE RADS | OTHER |