Civista Clinical Services, LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

CIVISTA CLINICAL SERVICES, LLC

Practice address

605 East Charles Street
La Plata, MD 20646

Phone

(301) 609-4800

Fax

(301) 609-5220

NPI assigned

Jul 13, 2007

Organization subpart

Yes

Parent organization

CIVISTA CLINICAL SERVICES, LLCAs reported in NPPES

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

Authorized official

Name

Stephanie Simm

Title

Physician Relations Specialists

Phone

(301) 609-4539

Specialties & licenses 1

Addresses

Other names 1

• University of Maryland Charles Regional OB/GYN Doing business as

Part of

Civista Clinical SRVC LLC

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1205035805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 EAST CHARLES STREET",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "20646",
            "telephone_number": "301-609-4800",
            "fax_number": "301-609-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 EAST CHARLES STREET",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "20646",
            "telephone_number": "301-609-4800",
            "fax_number": "301-609-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVISTA CLINICAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIVISTA CLINICAL SERVICES, LLC",
        "enumeration_date": "2007-07-13",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "SIMM",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PHYSICIAN RELATIONS SPECIALISTS",
        "authorized_official_telephone_number": "301-609-4539"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University of Maryland Charles Regional OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan Elise Cheatham-Jackson, PHARM D
• Patrick S Cieplak, DDS
• Citizens Run Inc
• Civista Clinical Sercives, LLC
• Civista Clinical Services, L.L.C.
• Civista Clinical Services, LLC
• Civista Clinical Services, LLC
• Civista Clinical Services, LLC
• Civista Medical Center Inc
• Civista Medical Center, Inc.

• Obstetrics & Gynecology Physician in La Plata, MD
• Providers in La Plata, MD by specialty
• Obstetrics & Gynecology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; 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.