Basic Information
| Provider Information | |||||||||
| NPI: | 1477517225 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUMINIS HEALTH ANNE ARUNDEL MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ANNE ARUNDEL MEDICAL CENTER, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 MEDICAL PKWY STE 606 | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811000 | ||||||||
| FaxNumber: | 4434811313 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 MEDICAL PARKWAY | ||||||||
| Address2: | HEALTH SCIENCES PAVILION - SUITE 606 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811000 | ||||||||
| FaxNumber: | 4434811313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 04/28/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | REILLY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4434811308 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 02003/5237 | MD | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 904376400 | 05 | FL | MEDICAID | HA6 | 01 | MD | GHMSI | OTHER | 145724700 | 01 | MD | US DEPT OF LABOR | OTHER | 397329 | 01 | MD | FEDERAL BLACK LUNG | OTHER | 5000056 | 01 | MD | UHCHMO & UHCMA | OTHER | 233918 | 01 | MD | MAMSI | OTHER | 8204000 | 05 | PA | MEDICAID | 00205400 | 05 | MD | MEDICAID | 2100231 | 05 | VA | MEDICAID | 885832 | 05 | OH | MEDICAID | 57639101 | 01 | MD | CAREFIRST BLUE CROSS/SH | OTHER | 483549 | 01 | MD | NCPPO | OTHER | 9814108 | 05 | WV | MEDICAID | 20229100 | 05 | DC | MEDICAID |