Provider Demographics
NPI:1053346759
Name:MERITUS MEDICAL CENTER INC
Entity type:Organization
Organization Name:MERITUS MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-790-8102
Mailing Address - Street 1:11116 MEDICAL CAMPUS RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6710
Mailing Address - Country:US
Mailing Address - Phone:301-790-8000
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 129
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-665-4650
Practice Address - Fax:301-797-9480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERITUS MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21-012282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNW5OtherBLUECROSS-FEP/GHMSI
MD263416OtherMAMSI-CHEMO
MD61284701OtherBLUECROSS-MARYLAND
MD363416OtherMAMSI-RADIATION
MD61284701OtherBLUECROSS-MARYLAND