Healthcare Provider Details

I. General information

NPI: 1265499016
Provider Name (Legal Business Name): WESTERN MARYLAND HEALTH SYSTEM CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 TARN TER
FROSTBURG MD
21532-1217
US

IV. Provider business mailing address

48 TARN TER
FROSTBURG MD
21532-1217
US

V. Phone/Fax

Practice location:
  • Phone: 301-689-1391
  • Fax: 301-689-6251
Mailing address:
  • Phone: 301-689-1391
  • Fax: 301-689-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number01-017
License Number StateMD

VIII. Authorized Official

Name: MRS. KIMBERLY S REPAC
Title or Position: SR. VP CFO
Credential:
Phone: 240-964-8003