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General NPI Number Information
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NPI Number | 1992701825
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Entity Type | Organization
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Legal Business Name | CIVISTA MEDICAL CENTER INC
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 5 GARRETT AVENUE
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City | LA PLATA
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State | MD
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Zip | 20646-1070
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Country | US
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Telephone | 301-609-4474
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Fax | 301-609-4411
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Provider Business Mailing Address
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Address Line | PO BOX 1070
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City | LA PLATA
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State | MD
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Zip | 20646-1070
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Country | US
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Telephone | 301-609-5163
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Fax | 301-934-0053
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | ALBERT ZANGER
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Credential |
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Telephone | 301-609-5163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number |
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License Number State | MD
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