Basic Information
| Provider Information | |||||||||
| NPI: | 1912904210 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARROLL HOSPITAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MEMORIAL AVE | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108483000 | ||||||||
| FaxNumber: | 4108716226 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MEMORIAL AVE | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108483000 | ||||||||
| FaxNumber: | 4108716226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | MYERS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4108483000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 06002 | MD | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 404990000 | 05 | MD | MEDICAID |