=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023007820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARRETT COUNTY MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2005
-----------------------------------------------------
Last Update Date | 07/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251 N FOURTH ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21550-1375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-533-4220
-----------------------------------------------------
Fax | 301-533-4208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 N FOURTH ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21550-1375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-533-4220
-----------------------------------------------------
Fax | 301-533-4208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP FINANCE CFO
-----------------------------------------------------
Name | MRS. TRACY DAWN LIPSCOMB
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 301-533-4171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 110005
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------