MEDICARE: PEOPLES COMMUNITY HEALTH 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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	H649	OTHER	MD	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1912976796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEOPLES COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	2204 MARYLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-5625
Country	:	US
Telephone Number	:	410-467-6040
Fax Number	:

Provider Business Practice Location Address
First Line	:	8341 PIONEER DRIVE
Second Line	:
City	:	SEVERN
State	:	MD
Zip	:	21144
Country	:	US
Telephone Number	:	410-467-6040
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. PATRICIA CASSATT
Credential	:	MS
Telephone Number	:	410-235-8801

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	12/12/2012

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