Provider Demographics
NPI:1063224327
Name:SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
Entity type:Organization
Organization Name:SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-533-4251
Mailing Address - Street 1:PO BOX 1647
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 N 4TH ST STE 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1371
Practice Address - Country:US
Practice Address - Phone:301-334-1034
Practice Address - Fax:301-334-3350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty