Provider Demographics
NPI:1538165527
Name:FREDERICK HEALTH HOSPITAL INC
Entity type:Organization
Organization Name:FREDERICK HEALTH HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AVP
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-566-3557
Mailing Address - Street 1:PO BOX 277045
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7045
Mailing Address - Country:US
Mailing Address - Phone:240-566-3300
Mailing Address - Fax:240-566-3892
Practice Address - Street 1:400 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4506
Practice Address - Country:US
Practice Address - Phone:240-566-3300
Practice Address - Fax:240-566-3892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICK HEALTH HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-23
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QX0203X
MD10001282N00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
211417OtherUNITED MAMSI
4020106OtherCIGNA
MD000235600Medicaid
482770OtherNCPPO
5000066OtherUNITED
6310365OtherAETNA PIN
0249OtherCAREFIRST MARYLAND
GN-4OtherCAREFIRST BCBS GHMSI
60286OtherAETNA PVN
60286OtherAETNA PVN