Provider Demographics
NPI:1871065813
Name:SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
Entity type:Organization
Organization Name:SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, CHFP
Authorized Official - Phone:301-533-4171
Mailing Address - Street 1:251 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1375
Mailing Address - Country:US
Mailing Address - Phone:301-533-4171
Mailing Address - Fax:
Practice Address - Street 1:69 WOLF ACRES DR LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-2046
Practice Address - Country:US
Practice Address - Phone:301-533-2190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)