NPIMap

Organization Active NPI

Queen Anne'S County Health Department

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Centreville, MD
National Provider Identifier
1174893556
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
750325 Issued in MD
Legal business name
QUEEN ANNE'S COUNTY HEALTH DEPARTMENT
Practice address
205 N Liberty St
Centreville, MD 21617-1022
Phone
(410) 758-1306
Fax
(410) 758-2133
NPI assigned
Jan 3, 2012
Organization subpart
Yes
Parent organization
QUEEN ANNE'S COUNTY HEALTH DEPARTMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Authorized official

Name
Mr. Gary B Fry, LCADC
Title
Program Director
Phone
(410) 758-1306

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 750325 MD Primary

Addresses

Primary practice location

205 N Liberty St
Centreville, MD 21617-1022

Mailing address

206 N Commerce St
Centreville, MD 21617-1049
Phone (410) 758-1306

Other identifiers 14

IdentifierTypeStateIssuer
420917600OtherMDJAI MEDICAL MA MCO
420917600OtherMDUNITED HEALTH CARE-MA MCO
01372281OtherMDAMERIGROUP MA MCO
420917600OtherMDMARYLAND PHYSICIANS CARE MA MCO
019364OtherMDRIVERSIDE MA MCO
019364OtherMDVALUE OPTIONS MA MCO
056064OtherMDPRIORITY PARTNERS PAC MCO
H93OtherMDCAREFIRST BCBS OF MD
01372281OtherMDAMERIGROUP PAC MCO
420917600OtherMDDIAMOND PLAN MA MCO
420917600OtherMDUNITED BEHAVIORAL HEALTH MA MCO
056064OtherMDPRIORITY PARTNERS MA MCO
420917600OtherMDMEDSTAR FAMILY MA MCO
420917600MedicaidMD

Other names 1

  • Queen Anne's County Alcohol and Drug Abuse Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Queen Annes County Heal7 organizations share this tax ID, including this one
Part of
Queen Annes County Heal

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": "1325548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1174893556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N COMMERCE ST",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "216171049",
            "telephone_number": "410-758-1306",
            "fax_number": "410-758-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N LIBERTY ST",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "216171022",
            "telephone_number": "410-758-1306",
            "fax_number": "410-758-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN ANNE'S COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUEEN ANNE'S COUNTY HEALTH DEPARTMENT",
        "enumeration_date": "2012-01-03",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "FRY",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "410-758-1306",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCADC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MD",
            "license": "750325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JAI MEDICAL MA MCO",
            "identifier": "420917600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE-MA MCO",
            "identifier": "420917600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP MA MCO",
            "identifier": "01372281",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND PHYSICIANS CARE MA MCO",
            "identifier": "420917600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RIVERSIDE MA MCO",
            "identifier": "019364",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS MA MCO",
            "identifier": "019364",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY PARTNERS PAC MCO",
            "identifier": "056064",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS OF MD",
            "identifier": "H93",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP PAC MCO",
            "identifier": "01372281",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DIAMOND PLAN MA MCO",
            "identifier": "420917600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH MA MCO",
            "identifier": "420917600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY PARTNERS MA MCO",
            "identifier": "056064",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDSTAR FAMILY MA MCO",
            "identifier": "420917600",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420917600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Queen Anne's County Alcohol and Drug Abuse Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centreville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.