NPIMap

Organization Active NPI

Type 1 Individual Provider

  • Exclusive Provider Organization
  • Silver Spring, MD
National Provider Identifier
1952543191
Registry record updated Apr 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
License
LC2381 Issued in MD
Legal business name
TYPE 1 INDIVIDUAL PROVIDER
Practice address
1620 Elton Rd
Silver Spring, MD 20903-1740
Phone
(301) 439-7191
NPI assigned
Apr 2, 2009
Last updated
Apr 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2009

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

Authorized official

Name
Ms. Brena Gibson, P.H.D
Title
Human Resources Director
Phone
(301) 439-7191

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X LC2381 MD Primary

Addresses

Primary practice location

1620 Elton Rd
Silver Spring, MD 20903-1740

Mailing address

1620 Elton Rd
Silver Spring, MD 20903-1740
Phone (301) 439-7191

Other names 1

  • Type 1 Individual Provider Other name

National Provider Directory

National Provider Directory
Tax ID family
Ephesians Life Ministries3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1620 Elton Rd
Silver Spring, MD 20903

NPI Registry JSON

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

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239148800000",
    "number": "1952543191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 ELTON RD",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209031740",
            "telephone_number": "301-439-7191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 ELTON RD",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209031740",
            "telephone_number": "301-439-7191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYPE 1 INDIVIDUAL PROVIDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-02",
        "last_updated": "2009-04-08",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "BRENA",
        "authorized_official_title_or_position": "HUMAN RESOURCES DIRECTOR",
        "authorized_official_telephone_number": "301-439-7191",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "P.H.D"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MD",
            "license": "LC2381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Type 1 Individual Provider",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Silver Spring, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; 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.