NPI:
1710689500
Provider Name:
MONTGOMERY COUNTY MARYLAND GOVERNMENT
Other Name: SOUTH LAKE ELEMENTARY SCHOOL BASED HEALTH CENTER
Classification:
Clinic/Center - 261QP0905X
Entity Type:
Organization
Specialization: Public Health, State or Local
CLIA Number: 21D2293722
Address:
18100 WASHINGTON GROVE LN
GAITHERSBURG, MD
ZIP 20877
Phone:
(240) 740-7330
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MONTGOMERY COUNTY MARYLAND GOVERNMENT is a public health and state or local clinic center in Gaithersburg, MD. MONTGOMERY COUNTY MARYLAND GOVERNMENT NPI is 1710689500. The provider is registered as an organization entity type.
The provider Other Name Is South Lake Elementary School Based Health Center.
The provider's business location address is:
18100 WASHINGTON GROVE LN
GAITHERSBURG, MD
ZIP 20877-054
Phone: (240) 740-7330
Fax: (301) 548-4966
The provider's authorized official is Nancy Flavia Bunyenyezi .
The authorized official title is Analyst and has the following contact phone number (240) 579-0206.
The CLIA number assigned to this NPI record is 21D2293722 - school/student health service with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 3/17/2023 and was last updated on 8/16/2023.