NPIMap

Organization Active NPI

State of the Body LLC

  • Primary Care Clinic/Center
  • Baltimore, MD
National Provider Identifier
1194541292
Registry record updated Nov 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
STATE OF THE BODY LLC
Doing business as
State of the Body LLC
Practice address
1133 Wedgewood Rd
Baltimore, MD 21229-1247
Phone
(919) 880-8115
NPI assigned
Nov 23, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2024

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

Authorized official

Name
Mrs. Eboni McCoy, NURSE PRACTITIONERNPI 1326552860
Title
President
Phone
(919) 880-8115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1133 Wedgewood Rd
Baltimore, MD 21229-1247

Mailing address

1133 Wedgewood Rd
Baltimore, MD 21229-1247
Phone (919) 880-8115

Other names 1

  • State of the Body LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1732320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732320000000",
    "number": "1194541292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 WEDGEWOOD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212291247",
            "telephone_number": "919-880-8115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 WEDGEWOOD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212291247",
            "telephone_number": "919-880-8115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF THE BODY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-23",
        "last_updated": "2024-11-23",
        "certification_date": "2024-11-23",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "EBONI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-880-8115",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State of the Body LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2024; 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.