NPIMap

Organization Active NPI

Prince George's County Health Department

  • Student Health Clinic/Center
  • Bladensburg, MD
National Provider Identifier
1194213728
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
Legal business name
PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Practice address
4200 57TH Ave
Bladensburg, MD 20710-1710
Phone
(240) 696-3356
Fax
(301) 883-7890
NPI assigned
Apr 30, 2018
Last updated
Sep 17, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PRINCE GEORGE'S COUNTY HEALTH DEPARTMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Tamala Butler
Title
Credentialing Specialist
Phone
(301) 883-7822

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Family Medicine) Physician 207QA0000X NU
Student Health Clinic/Center 261QS1000X NU Primary

Addresses

Primary practice location

4200 57TH Ave
Bladensburg, MD 20710-1710

Mailing address

1701 McCormick Dr Ste 120
Largo, MD 20774-5329
Phone (301) 883-7822

Other names 1

  • Prince George's County Health Department-SBW-Bladensburg Other name

National Provider Directory

National Provider Directory
Tax ID family
Prince Georges County Health Dept48 organizations share this tax ID, including this one
Part of
Prince Georges County Health Dept

Other organizations with this tax ID 47

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

View all 47

Locations

4200 57th Ave
Bladensburg, MD 20710
Phone (240) 696-3356

NPI Registry JSON

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

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1194213728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 MCCORMICK DR STE 120",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207745329",
            "telephone_number": "301-883-7822",
            "fax_number": "301-883-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 57TH AVE",
            "city": "BLADENSBURG",
            "state": "MD",
            "postal_code": "207101710",
            "telephone_number": "240-696-3356",
            "fax_number": "301-883-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT",
        "enumeration_date": "2018-04-30",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "TAMALA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "301-883-7822"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prince George's County Health Department-SBW-Bladensburg",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bladensburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.