Active NPI
Lower Shore Clinic, Inc.
- Community/Behavioral Health Agency
- Centreville, MD
National Provider Identifier
1770716458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- 23646
- Legal business name
- LOWER SHORE CLINIC, INC.
- Practice address
- 120 Banjo LN
Centreville, MD 21617-1002 - Phone
- (410) 341-3420
- Fax
- (410) 341-3397
- NPI assigned
- Aug 28, 2009
- Organization subpart
- Yes
- Parent organization
- LOWER SHORE CLINIC, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tuesday Trott
- Title
- Administrator
- Phone
- (410) 341-3420
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 23646 | MD | Primary |
Addresses
Primary practice location
120 Banjo LN
Centreville, MD 21617-1002
Mailing address
716 N Division St
Salisbury, MD 21801-4156
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 298470901 | Medicaid | MD |
Other names 1
- Corsica River Mental Health Services
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051102000426 | MD | Part B Supplier - Clinic/Group Practice | 2365469947 |
Receives reassigned benefits from 15 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Newark, MD; Salisbury, MD; Princess Anne, MD; Cambridge, MD |
Other NPIs on the same Medicare enrollment 7
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Salisbury, MD
- NPI 1154320646
O20051102000426
National Provider Directory
National Provider Directory- Part of
- Healthport
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251417600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1251936000000",
"number": "1770716458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "716 N DIVISION ST",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218014156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 BANJO LN",
"city": "CENTREVILLE",
"state": "MD",
"postal_code": "216171002",
"telephone_number": "410-341-3420",
"fax_number": "410-341-3397"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LOWER SHORE CLINIC, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LOWER SHORE CLINIC, INC.",
"enumeration_date": "2009-08-28",
"last_updated": "2009-09-03",
"status": "A",
"authorized_official_last_name": "TROTT",
"authorized_official_first_name": "TUESDAY",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "410-341-3420"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "MD",
"license": "23646",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "298470901",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Corsica River Mental Health Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Centreville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.