NPIMap

Organization Active NPI

Civista Medical Center, Inc.

Doing business as University of Maryland Charles Regional Medical Center

  • Clinical Medical Laboratory
  • La Plata, MD
National Provider Identifier
1801461926
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CIVISTA MEDICAL CENTER, INC.
Doing business as
University of Maryland Charles Regional Medical Center
Practice address
5 Garrett Ave
La Plata, MD 20646-5960
Phone
(301) 609-4000
Fax
(301) 609-4411
NPI assigned
May 21, 2021
Last updated
May 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Authorized official

Name
Albert Zanger
Title
Cfo
Phone
(301) 609-5163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

5 Garrett Ave
La Plata, MD 20646-5960

Mailing address

PO Box 1070
La Plata, MD 20646-1070
Phone (301) 609-5163

Other names 1

  • University of Maryland Charles Regional Medical Center Doing business as

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
21D0209552University of MD Charles Regional Med Ctr Lab5 Garrett Avenue, La Plata, MD 20646AccreditationFeb 27, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

10 N La Plata Ct
La Plata, MD 20646
Phone (301) 609-5494

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1801461926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1070",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206461070",
            "telephone_number": "301-609-5163",
            "fax_number": "301-934-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GARRETT AVE",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465960",
            "telephone_number": "301-609-4000",
            "fax_number": "301-609-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVISTA MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "ZANGER",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-609-5163"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University of Maryland Charles Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 21, 2021; 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.