Basic Information
| Provider Information | |||||||||
| NPI: | 1891925814 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTERN MARYLAND HEALTH SYSTEM CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WMHS URGENT CARE SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12500 WILLOWBROOK RD | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215026393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2409648342 | ||||||||
| FaxNumber: | 3017231480 | ||||||||
| Practice Location | |||||||||
| Address1: | 12500 WILLOWBROOK RD | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215026393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2409648342 | ||||||||
| FaxNumber: | 3017231480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2009 | ||||||||
| LastUpdateDate: | 07/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | REPAC | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 2409647233 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WESTERN MARYLAND HEALTH SYSTEM CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.