1336193887 NPI number — STAGGERS HEARE & WHITEMAN PA

Table of content: (NPI 1336193887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336193887 NPI number — STAGGERS HEARE & WHITEMAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAGGERS HEARE & WHITEMAN PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROGRESSIVE PHYSICAL THERAPY & REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336193887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11801 UPPER POTOMAC INDSTRL PARK ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-5139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-729-3485
Provider Business Mailing Address Fax Number:
301-729-0158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11801 UPPER POTOMAC INDSTRL PARK ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-5139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-729-3485
Provider Business Practice Location Address Fax Number:
301-729-0158
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITEMAN, JR.
Authorized Official First Name:
ROY
Authorized Official Middle Name:
DAVID RUSSELL
Authorized Official Title or Position:
PRESIDENT/OFFICER
Authorized Official Telephone Number:
301-729-3485

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116441251494 . This is a "HUMANA INSURANCE CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: CM4138 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: R950 . This is a "CAREFIRST BCBS OF DC NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: S986 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1017320 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810003745 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11015 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5766011 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810003745 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 222830 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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