NPIMap

Organization Active NPI

Civista Clinical Services, L.L.C.

  • Hospitalist Physician
  • La Plata, MD
National Provider Identifier
1447450176
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
CIVISTA CLINICAL SERVICES, L.L.C.
Practice address
701 Charles St
La Plata, MD 20646-5930
Phone
(301) 609-4000
NPI assigned
Jul 20, 2007
Organization subpart
Yes
Parent organization
CIVISTA CARE PARTNERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

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

Authorized official

Name
Gary Herbek
Title
SVP Coo
Phone
(301) 609-4141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary

Addresses

Primary practice location

701 Charles St
La Plata, MD 20646-5930

Mailing address

PO Box 1070
701 East Charles Street
La Plata, MD 20646-1070
Phone (301) 609-4000

National Provider Directory

National Provider Directory
Tax ID family
Civista Clinical SRVC LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1447450176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1070",
            "address_2": "701 EAST CHARLES STREET",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206461070",
            "telephone_number": "301-609-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CHARLES ST",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465930",
            "telephone_number": "301-609-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVISTA CLINICAL SERVICES, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIVISTA CARE PARTNERS, INC.",
        "enumeration_date": "2007-07-20",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "HERBEK",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "SVP COO",
        "authorized_official_telephone_number": "301-609-4141"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Plata, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; 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.