NPIMap

Organization Active NPI

Tidalhealth Peninsula Regional, Inc.

  • Clinical Medical Laboratory
  • Salisbury, MD
National Provider Identifier
1427298629
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
22-003 Issued in MD
Legal business name
TIDALHEALTH PENINSULA REGIONAL, INC.
Practice address
100 E Carroll St
Salisbury, MD 21801-5422
Phone
(410) 543-7437
Fax
(410) 543-7020
NPI assigned
Feb 27, 2009
Last updated
Nov 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Authorized official

Name
Mrs. Mickey M Griffin, CRCE
Title
Director, PFS
Phone
(410) 543-7437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 22-003 MD Primary

Addresses

Primary practice location

100 E Carroll St
Salisbury, MD 21801-5422

Mailing address

PO Box 2498
Salisbury, MD 21802-2498
Phone (410) 543-7437

Other identifiers 1

IdentifierTypeStateIssuer
401428600MedicaidMD

Other names 1

  • TidalHealth Family Lab Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D0221168Tidalhealth Peninsula Regional Inc100 East Carroll Street, Salisbury, MD 21801AccreditationFeb 27, 2027
21D0695277Tidalhealth Peninsula Regional Inc Abg Lab100 East Carroll Street, Salisbury, MD 21801AccreditationJan 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peninsula Reg Med Ctr33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1235692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1427298629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2498",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218022498",
            "telephone_number": "410-543-7437",
            "fax_number": "410-543-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E CARROLL ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015422",
            "telephone_number": "410-543-7437",
            "fax_number": "410-543-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH PENINSULA REGIONAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-27",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "MICKEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR, PFS",
        "authorized_official_telephone_number": "410-543-7437",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRCE"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "22-003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "401428600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TidalHealth Family Lab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.