NPI |
1932668506 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Employer Identification Number EIN |
|
The country code in the location address of the provider being identified. |
Provider Organization Name Legal Business Name |
FREE BALTIMORE, LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
1120 N CHARLES ST STE 303 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
BALTIMORE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MD |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
212015592 |
The title or position of the authorized official. |
Provider Business Practice Location Address Country Code If outside U S |
US |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Telephone Number |
4437597075 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
3/13/2019 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
12/6/2022 |
|
Authorized Official Last Name |
SERVICES |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
NORTHWEST REGISTERED |
The first name of the authorized official. |
Authorized Official Middle Name |
AGENT |
The middle name of the authorized official. |
Authorized Official Title or Position |
REGISTERED AGENT |
The title or position of the authorized official. |
Authorized Official Telephone Number |
4434165667 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
251S00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
NPI Certification Date |
11/22/2022 |
|