MEDICARE: FREDERICK HEALTH HOSPITAL 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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician
2	246X00000X	Cardiovascular Specialist/Technologist
3	261QR0206X	Mammography Clinic/Center
4	291U00000X	Clinical Medical Laboratory	21D0220586	MD
5	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1982600771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDERICK HEALTH HOSPITAL INC

Provider Business Mailing Address
First Line	:	PO BOX 277045
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-7045
Country	:	US
Telephone Number	:	240-566-3330
Fax Number	:	240-566-3892

Provider Business Practice Location Address
First Line	:	1562 OPOSSUMTOWN PIKE
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4337
Country	:	US
Telephone Number	:	240-566-3400
Fax Number	:	240-566-3125

Authorized Official
Title or Position	:	CFO AND SR. VP
Name	:	MS. HANNAH JACOBS
Credential	:
Telephone Number	:	240-566-3355

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/06/2022

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