SOUTH MOUNTAIN COMMUNITY HEALTH LLC NPI 1932388493

NPI Information

NPI: 1932388493
Provider Name: SOUTH MOUNTAIN COMMUNITY HEALTH LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 21D1037668

Address:
9 SAINT PAUL ST STE 3
BOONSBORO, MD
ZIP 21713
Phone: (301) 432-6897
Get Directions

SOUTH MOUNTAIN COMMUNITY HEALTH LLC is a family nurse practitioner in Boonsboro, MD. SOUTH MOUNTAIN COMMUNITY HEALTH LLC NPI is 1932388493. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

9 SAINT PAUL ST STE 3
BOONSBORO, MD
ZIP 21713
Phone: (301) 432-6897
Fax: (301) 432-6298

The provider's authorized official is Tracey Galloway Elizalde .
The authorized official title is Owner and has the following contact phone number (301) 432-6897.

The CLIA number assigned to this NPI record is 21D1037668 - practitioner other with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/31/2007 and was last updated on 7/23/2018.

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	363LF0000X	Nurse Practitioner	Family	R100650	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	544300800	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: 5/5/2024

NPI Synchronization or Removal

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