Healthcare Provider Details

I. General information

NPI: 1609029248
Provider Name (Legal Business Name): EXTRA MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7437 GUM SPRING RD # B
ROSEDALE MD
21237-3704
US

IV. Provider business mailing address

7437 GUM SPRING RD # B
ROSEDALE MD
21237-3704
US

V. Phone/Fax

Practice location:
  • Phone: 410-937-6900
  • Fax: 301-422-2993
Mailing address:
  • Phone: 410-937-6900
  • Fax: 301-422-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License NumberR2264
License Number StateMD

VIII. Authorized Official

Name: DR. DOMINIC CHIMEZIE AMAECCHI
Title or Position: ADMINISTRATOR
Credential: RRT, CPFT,JD
Phone: 410-937-6900