Provider Demographics
NPI:1285175299
Name:HILLCREST SCHOOL-BASED HEALTH CENTER
Entity type:Organization
Organization Name:HILLCREST SCHOOL-BASED HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPURRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-600-3955
Mailing Address - Street 1:100 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5527
Mailing Address - Country:US
Mailing Address - Phone:301-600-1506
Mailing Address - Fax:301-662-9079
Practice Address - Street 1:1285 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-1396
Practice Address - Country:US
Practice Address - Phone:240-236-3275
Practice Address - Fax:240-236-3293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF FREDERICK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-10
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD080142OtherDHMH LETTER OF PERMIT EXCEPTION