=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326426990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID ATLANTIC CAT HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2015
-----------------------------------------------------
Last Update Date | 05/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 GRANGE HALL RD
-----------------------------------------------------
City | QUEENSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21658-1386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-827-7788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 GRANGE HALL RD
-----------------------------------------------------
City | QUEENSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21658-1386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-827-7788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. ANN RENEE RUCINSKY
-----------------------------------------------------
Credential | DVM, DABVP
-----------------------------------------------------
Telephone | 410-827-7788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 284300000X
-----------------------------------------------------
Taxonomy Name | Special Hospital
-----------------------------------------------------
License Number | 5252
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------