Basic Information
| Provider Information | |||||||||
| NPI: | 1144333923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHNS HOPKINS BAYVIEW MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 632064 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212632064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439970001 | ||||||||
| FaxNumber: | 4439970011 | ||||||||
| Practice Location | |||||||||
| Address1: | 5505 HOPKINS BAYVIEW CIRCLE | ||||||||
| Address2: | JOHNS HOPKINS BAYVIEW CARE CENTER | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105500756 | ||||||||
| FaxNumber: | 4105501190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 06/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | WERTHMAN | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VP, FINANCE, TREASUER, CFO, JHHS | ||||||||
| AuthorizedOfficialTelephone: | 4109556552 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 30086 | MD | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 371497700 | 05 | MD | MEDICAID |