Healthcare Provider Details

I. General information

NPI: 1932980695
Provider Name (Legal Business Name): EAGLE MEDICAL 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 POWDER MILL RD STE 450Z8
BELTSVILLE MD
20705-2675
US

IV. Provider business mailing address

4600 POWDER MILL RD STE 450Z8
BELTSVILLE MD
20705-2675
US

V. Phone/Fax

Practice location:
  • Phone: 888-533-2949
  • Fax:
Mailing address:
  • Phone: 888-533-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: STANLEY NICHOLAS
Title or Position: MANAGER
Credential:
Phone: 888-533-2949