SIMPLY 4 KIDZ HEALTHCARE LLC NPI 1699220731

NPI Information

NPI: 1699220731
Provider Name: SIMPLY 4 KIDZ HEALTHCARE, LLC
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Organization

Specialization: Pediatrics

CLIA Number: 21D2118096

Address:
265 MILL ST
SUITE 800
HAGERSTOWN, MD
ZIP 21740
Phone: (240) 513-4595
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SIMPLY 4 KIDZ HEALTHCARE, LLC is a pediatrics nurse practitioner in Hagerstown, MD. SIMPLY 4 KIDZ HEALTHCARE, LLC NPI is 1699220731. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

265 MILL ST
SUITE 800
HAGERSTOWN, MD
ZIP 21740-130
Phone: (240) 513-4595
Fax: (240) 513-4596

The provider's authorized official is Teresa Marie Lum .
The authorized official title is Owner and has the following contact phone number (240) 513-4595.

The CLIA number assigned to this NPI record is 21D2118096 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/18/2016 and was last updated on 8/18/2016.

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
1	363LP0200X	Nurse Practitioner	Pediatrics	R109055	MARYLAND	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	807602200	MEDICAID	MARYLAND

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

NPI Synchronization or Removal

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