MEDICAL PRACTICES OF ANTIETAM LLC NPI 1316620743

NPI Information

NPI: 1316620743
Provider Name: MEDICAL PRACTICES OF ANTIETAM, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
11110 MEDICAL CAMPUS RD STE 242
HAGERSTOWN, MD
ZIP 21742
Phone: (240) 513-7072
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MEDICAL PRACTICES OF ANTIETAM, LLC is an ambulatory surgical clinic center in Hagerstown, MD. MEDICAL PRACTICES OF ANTIETAM, LLC NPI is 1316620743. The provider is registered as an organization entity type.

The provider's business location address is:

11110 MEDICAL CAMPUS RD STE 242
HAGERSTOWN, MD
ZIP 21742-728
Phone: (240) 513-7072

The provider's authorized official is Joshua Repac .
The authorized official title is Chief Financial Officer and has the following contact phone number (301) 790-9351.

The enumeration date for this NPI number is 8/11/2023 and was last updated on 8/11/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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