75TH Street Injury & Illness Center LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

75TH STREET INJURY & ILLNESS CENTER LLC

Practice address

7408 Coastal Hwy
Ocean City, MD 21842-2936

Phone

(410) 524-0075

NPI assigned

Oct 5, 2017

Organization subpart

No

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

Authorized official

Name

Cynthia W Randolph, PA-C

Title

Administrator

Phone

(410) 524-0075

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1507161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507161600000",
    "number": "1245740109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12547 OCEAN GTWY",
            "city": "OCEAN CITY",
            "state": "MD",
            "postal_code": "218429689",
            "telephone_number": "410-213-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7408 COASTAL HWY",
            "city": "OCEAN CITY",
            "state": "MD",
            "postal_code": "218422936",
            "telephone_number": "410-524-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "75TH STREET INJURY & ILLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-05",
        "last_updated": "2017-10-05",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "410-524-0075",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 126TH Street Medical
• 75TH Street Medical PA
• A Home for Life, Inc.
• Access Primary Care LLC
• Accurate Optical Co of Ocean City Inc
• Acute Injury and Illness Centers LLC

• Emergency Medicine Physician in Ocean City, MD
• Providers in Ocean City, MD by specialty
• Emergency Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; 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.