NPIMap

Organization Active NPI

Chester River Health Lab - Centreville

  • Clinical Medical Laboratory
  • Chestertown, MD
National Provider Identifier
1154628188
Registry record updated Feb 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
21D022037 Issued in MD
Legal business name
CHESTER RIVER HEALTH LAB - CENTREVILLE
Practice address
100 Brown St
Chestertown, MD 21620-1435
Phone
(410) 778-3300
NPI assigned
Feb 28, 2011
Organization subpart
Yes
Parent organization
CHESTER RIVER HOSPITAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2011

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

Authorized official

Name
Mrs. Cardella Trythall Forrester, CPAM, CHAM
Title
Director, Patient Financial Service
Phone
(410) 810-5192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 21D022037 MD Primary

Addresses

Primary practice location

100 Brown St
Chestertown, MD 21620-1435

Mailing address

202 Coursevall Dr
Suite 107
Centreville, MD 21617-2804
Phone (410) 778-3300

Other identifiers 1

IdentifierTypeStateIssuer
000265800MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Chester River Health Lab7 organizations share this tax ID, including this one
Part of
Chester River Health Lab

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298851200000",
    "number": "1154628188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 COURSEVALL DR",
            "address_2": "SUITE 107",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "216172804",
            "telephone_number": "410-778-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BROWN ST",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216201435",
            "telephone_number": "410-778-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTER RIVER HEALTH LAB - CENTREVILLE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHESTER RIVER HOSPITAL CENTER",
        "enumeration_date": "2011-02-28",
        "last_updated": "2011-02-28",
        "status": "A",
        "authorized_official_last_name": "FORRESTER",
        "authorized_official_first_name": "CARDELLA",
        "authorized_official_middle_name": "TRYTHALL",
        "authorized_official_title_or_position": "DIRECTOR, PATIENT FINANCIAL SERVICE",
        "authorized_official_telephone_number": "410-810-5192",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPAM, CHAM"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "21D022037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000265800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chestertown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; 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.