Healthcare Provider Details

I. General information

NPI: 1457302713
Provider Name (Legal Business Name): HOSPITAL PHYSICIAN SERVICES, LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL AVE
WESTMINSTER MD
21157-5726
US

IV. Provider business mailing address

PO BOX 22249
BALTIMORE MD
21203-4249
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-3000
  • Fax:
Mailing address:
  • Phone: 301-652-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH S FASTOW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-652-2707