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Tidalhealth Peninsula Regional, Inc.

Organization Active NPI Health Service Clinic/Center · Salisbury, MD

NPI 1982171005 · NPPES record last updated Oct 26, 2020

Key facts

NPI
1982171005
Entity type
Organization (NPI type 2)
Primary specialty
Health Service Clinic/Center 261QH0100X
Legal business name
TIDALHEALTH PENINSULA REGIONAL, INC.
Practice address
106 Milford St Ste 404
Salisbury, MD 21804-6967
Phone
(410) 543-7294
NPI assigned
Oct 26, 2018
Organization subpart
No

Authorized official

Name
Mrs. Mickey Griffin
Title
Director of Patient Financial Serv
Phone
(410) 543-7437

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 32

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

View all 32

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2259406Tidalhealth Peninsula Regional Inc Richard a Henso
106 Milford Street Suite 603, Salisbury, MD 21804		Certificate of waiverMay 4, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MD

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190304002150 MD Part B Supplier - Hospital Department(S) 3072509702 Receives reassigned benefits from 1 practitioner
Practice locations: Salisbury, MD

National Provider Directory

Tax ID family
Peninsula Regional Medical Center (33 organizations share this tax ID)

Locations

1336 Belmont Ave
Ste 501A
Salisbury, MD 21804
Phone (410) 543-7475

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Yes
General Acute Care Hospital 282N00000X

Addresses

Primary practice location

106 Milford St Ste 404
Salisbury, MD 21804-6967

Mailing address

100 E Carroll St
Salisbury, MD 21801-5422
Phone (410) 543-7437

Other practice location 1

1336 Belmont Ave Ste 501A
Salisbury, MD 21804-4500
Phone (410) 543-7475

Other providers in Salisbury, MD

All providers in Salisbury, MD · Health Service Clinic/Center in Maryland

Sources for this page

Verify at the official NPI Registry.