MEDICARE: MEDSTAR GEORGETOWN MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1417272105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAR GEORGETOWN MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 630023
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21263-0023
Country	:	US
Telephone Number	:	800-508-6964
Fax Number	:	262-240-2383

Provider Business Practice Location Address
First Line	:	10201 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-5752
Country	:	US
Telephone Number	:	800-508-6964
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, CONTRACTING AND CLAIMS
Name	:	MRS. PAM HARRISON
Credential	:
Telephone Number	:	410-933-3075

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/21/2010

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