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TIDALHEALTH SPECIALTY CARE LLC NPI 1619504735


NPI Information

NPI: 1619504735
Provider Name: TIDALHEALTH SPECIALTY CARE, LLC
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

CLIA Number: 21D2261882

Address:
100 E CARROLL ST
SALISBURY, MD
ZIP 21801
Phone: (410) 546-6400
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TIDALHEALTH SPECIALTY CARE, LLC is a medical specialty clinic center in Salisbury, MD. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). TIDALHEALTH SPECIALTY CARE, LLC NPI is 1619504735. The provider is registered as an organization entity type.

The provider's business location address is:

100 E CARROLL ST
SALISBURY, MD
ZIP 21801-422
Phone: (410) 546-6400
Fax: (410) 912-4972

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 CLIA number assigned to this NPI record is 21D2261882 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/26/2020 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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2500XClinic/CenterMedical SpecialtyYes

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: 5/5/2024

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.