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TIDALHEALTH PENINSULA REGIONAL INC. NPI 1184832040


NPI Information

NPI: 1184832040
Provider Name: TIDALHEALTH PENINSULA REGIONAL, INC.
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
100 E CARROLL ST
PENINSULA REGIONAL MEDICAL GROUP
SALISBURY, MD
ZIP 21801
Phone: (410) 543-7252
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TIDALHEALTH PENINSULA REGIONAL, INC. is a family medicine in Salisbury, MD. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. TIDALHEALTH PENINSULA REGIONAL, INC. NPI is 1184832040. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

100 E CARROLL ST
PENINSULA REGIONAL MEDICAL GROUP
SALISBURY, MD
ZIP 21801-422
Phone: (410) 543-7252
Fax: (410) 912-6386

The provider's authorized official is Stephanie Gary .
The authorized official title is Cfo and has the following contact phone number (410) 912-6059.

The enumeration date for this NPI number is 5/21/2007 and was last updated on 2/28/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207P00000XEmergency MedicineNo
2207R00000XInternal MedicineNo
3207RE0101XInternal MedicineEndocrinology, Diabetes & MetabolismNo
4207RG0100XInternal MedicineGastroenterologyNo
5207RH0003XInternal MedicineHematology & OncologyNo
6207RP1001XInternal MedicinePulmonary DiseaseNo
7207T00000XNeurological SurgeryNo
8208000000XPediatricsNo
9208D00000XGeneral PracticeNo
10208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)No
11261QM0850XClinic/CenterAdult Mental HealthNo
12261QM0855XClinic/CenterAdolescent and Children Mental HealthNo
13363A00000XPhysician AssistantNo
14363LF0000XNurse PractitionerFamilyNo
15207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1CC4271OTHERMARYLANDMEDICARE RRB
2CA8333OTHERMARYLANDMEDICARE RRB
30000241502MEDICAIDDELAWARE
4C10607OTHERVIRGINIAMEDICARE PTAN
5K230OTHERMARYLANDMEDICARE NSC
6K230OTHERMARYLANDMEDICARE PTAN
7401428600MEDICAIDMARYLAND
8CA8334OTHERDELAWAREMEDICARE RRB
9G01753OTHERDELAWAREMEDICARE NSC
10525701800MEDICAIDMARYLAND
11C10607OTHERVIRGINIAMEDICARE NSC
12CC3716OTHERMARYLANDMEDICARE RRB
13G01753OTHERDELAWAREMEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.