Basic Information
| Provider Information | |||||||||
| NPI: | 1295786085 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARRETT COUNTY HEALTH DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215504343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013347706 | ||||||||
| FaxNumber: | 3013347701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215504343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013347706 | ||||||||
| FaxNumber: | 3013347701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | ROSE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | FISCAL ACCOUNTS CLERK | ||||||||
| AuthorizedOfficialTelephone: | 3013347673 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 904847 | MD | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 423207100 | 05 | MD | MEDICAID | 006180 | 01 | MD | BEACON HEALTH OPTIONS | OTHER | VA07 | 01 | MD | MEDICARE PTAN | OTHER |