Provider Demographics
NPI:1992701825
Name:CIVISTA MEDICAL CENTER INC
Entity type:Organization
Organization Name:CIVISTA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-609-5163
Mailing Address - Street 1:PO BOX 1070
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-1070
Mailing Address - Country:US
Mailing Address - Phone:301-609-5163
Mailing Address - Fax:301-934-0053
Practice Address - Street 1:5 GARRETT AVENUE
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-1070
Practice Address - Country:US
Practice Address - Phone:301-609-4474
Practice Address - Fax:301-609-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003355200Medicaid
MD210035Medicare ID - Type Unspecified