=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205282464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANCIS SCOTT KEY MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2016
-----------------------------------------------------
Last Update Date | 06/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4940 EASTERN AVE BLDG 01-0154
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21224-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-550-0961
-----------------------------------------------------
Fax | 410-550-5566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4940 EASTERN AVE BLDG 01-0154
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21224-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-550-0961
-----------------------------------------------------
Fax | 410-550-5566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO, JHBMC
-----------------------------------------------------
Name | CARL FRANCIOLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-288-8022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | P02057
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------