Basic Information
| Provider Information | |||||||||
| NPI: | 1881683423 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MCCREADY FOUNDATION, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EDWARD MCCREADY MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 HALL HWY | ||||||||
| Address2: | |||||||||
| City: | CRISFIELD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218171237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109681200 | ||||||||
| FaxNumber: | 4109681025 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 HALL HWY | ||||||||
| Address2: | |||||||||
| City: | CRISFIELD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218171237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109681200 | ||||||||
| FaxNumber: | 4109681025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COLLINS | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4109681200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QA1903X | 19-001 | MD | X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 225100000X | X | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 282N00000X | 19-001 | MD | X | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 131292 | 01 | MD | PRIORITY PARTNERS CLINIC | OTHER | 110988 | 01 | MD | PRIORITY PARTNERS ANESTH | OTHER | 49827 | 01 | AMERICAID | OTHER | 059693 | 01 | MD | PRIORITY PARTNERS OT | OTHER | 235089 | 01 | MD | MAMSI | OTHER | 236781500 | 05 | MH | MEDICAID | 9805516 | 05 | VA | MEDICAID | 000285200 | 05 | MD | MEDICAID | 5000064 | 01 | UNITED HEALTH CARE MCO | OTHER | 0126401 | 01 | UNITED HEALTH CARE | OTHER | 1059279 | 01 | KEYSTONE | OTHER | 57350401 | 01 | CAREFIRST BCBS | OTHER | MC9 | 01 | BCBS NCA | OTHER | 000358106 | 05 | DE | MEDICAID | 132748 | 01 | MD | PRIORITY PARTNERS | OTHER |