Indepth Healthcare Services LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

INDEPTH HEALTHCARE SERVICES LLC

Practice address

9244 Homestretch CT
Laurel, MD 20723-1875

Phone

(240) 308-2530

NPI assigned

Oct 13, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacqueline Annan, MSN

Title

Provider

Phone

(240) 308-2530

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634083200000",
    "number": "1104588466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9244 HOMESTRETCH CT",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207231875",
            "telephone_number": "240-308-2530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9244 HOMESTRETCH CT",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207231875",
            "telephone_number": "240-308-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPTH HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-13",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "ANNAN",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "240-308-2530",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "EHR",
            "affiliation": "N",
            "endpointDescription": "Office ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "EMR",
            "address_1": "9244 Homestretch Ct",
            "city": "Laurel",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207231875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.