=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427775329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAILWINDS MEDICAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2022
-----------------------------------------------------
Last Update Date | 09/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6640 FRIENDSHIP RD
-----------------------------------------------------
City | PITTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21850-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-521-6638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6640 FRIENDSHIP RD
-----------------------------------------------------
City | PITTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21850-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-521-6638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRANDON MCMULLEN
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 443-521-6638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------