SOUTHBRIDGE MEDICAL ADVISORY COUNCIL INC (NPI# 1770699621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1770699621 |
Entity Type | Organization |
Organization Name | SOUTHBRIDGE MEDICAL ADVISORY COUNCIL INC |
Other Organization Name | HENRIETTA JOHNSON MEDICAL CENTER |
Practice Address |
601 New Castle Ave Wilmington DE 19801 |
Practice Telephone | 3026556187 |
Practice Fax Number | 3026556606 |
Mailing Telephone | 3026556187 |
Mailing Fax Number | 3026556606 |
Enumeration Date | 2006-08-22 |
Last Update Date | 2013-01-16 |
Authorized Official Name | MS. ROSA V RIVERA (CHIEF EXECUTIVE OFFICER) |
Authorized Official Telephone | 3026556187 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 122300000X | Dentist | Dental Providers | ||
N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
N | 207VG0400X |
Obstetrics & Gynecology Specialization: Gynecology |
Allopathic & Osteopathic Physicians | ||
Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
DE | 0000332866 | 05 | |
TRAIL BLAZER | 458117 | 01 |
Other Name | Type Code |
---|---|
Henrietta Johnson Medical Center | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639417280 | Southbridge Medical Advisory Council Inc | Dentist | 600 N Lombard St, Wilmington, DE 19801-4429 | 2013-01-16 |
Street Address |
601 NEW CASTLE AVE |
City | WILMINGTON |
State | DE |
Zip Code | 19801 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710901012 | Charles G Case | Family Medicine | 601 New Castle Ave, Wilmington, DE 19801-5821 | 2006-07-27 |
1609389477 | Valeria Marie Muhammad | Nurse Practitioner | 601 New Castle Ave, Wilmington, DE 19801-5821 | 2017-11-14 |
1013447952 | Vavah Fiase | Physician Assistant | 601 New Castle Ave, Wilmington, DE 19801-5821 | 2017-06-13 |
1881138337 | Tina Solomon | Nurse Practitioner | 601 New Castle Ave, Wilmington, DE 19801-5821 | 2016-12-16 |
1063816312 | Lekesha Mcphail | Registered Nurse | 601 New Castle Ave, Wilmington, DE 19801-5821 | 2014-10-15 |
1073944773 | Stacy Bradshaw | Nurse Practitioner | 601 New Castle Ave, Wilmington, DE 19801-5821 | 2013-12-05 |
1407117724 | Stanley Ogden Dunn Jr. | Pediatrics | 601 New Castle Ave, Wilmington, DE 19801-5821 | 2012-06-04 |
1235386939 | Jendayi Gantt | Advanced Practice Midwife | 601 New Castle Ave, Wilmington, DE 19801-5821 | 2008-08-25 |
1750406955 | Flavius A. Akerele | Obstetrics & Gynecology | 601 New Castle Ave, Wilmington, DE 19801-5821 | 2007-03-20 |
1083747521 | Zita Aquino | Dentist | 601 New Castle Ave, Dental Clinic, Wilmington, DE 19801-5821 | 2007-03-13 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1386126068 | Meghan Cullen | Specialist/Technologist | 401 Garasches Lane, Wilmington, DE 19801 | 2018-08-30 |
1497257851 | Jevs Human Services | Psychologist | 300 Delaware Avenue, Suite 210, Wilmington, DE 19801 | 2018-03-01 |
1134627144 | Limen House, Inc | Substance Abuse Rehabilitation Facility | 1104 N. Adams Street / Triad, Wilmington, DE 19801 | 2018-01-24 |
1538698980 | Triad Ministry Inc | Community/Behavioral Health | 1104 N. Adams Street, Wilmington, DE 19801 | 2017-06-08 |
1649706086 | Fhr -act Program | Health Maintenance Organization | 103a Rogers Rd., Wilmington, DE 19801 | 2017-05-04 |
1275080707 | Suzanne Isenberg | Social Worker | 103 Rogers Roaad, Wilmington, DE 19801 | 2016-09-01 |
1467815191 | Jenna Leigh Laughlin | Internal Medicine | 501 W 14th St., Wilmington, DE 19801 | 2016-03-31 |
1962830430 | Antoinette L. Rodriguez | Counselor | 500 W 10th St., Connections Community Support Programs Inc., Wilmington, DE 19801 | 2013-10-21 |
1104173509 | Connections Community Support Programs, Inc. | Clinic/Center | 500 W. 10th Street, Wilmington, DE 19801 | 2012-08-06 |
1366719916 | Richard Mclaughlin | Counselor | 109 W. 7th St, Crossroads of Delaware, Wilmington, DE 19801 | 2011-11-28 |
Find all providers in zip 19801 |
Taxonomy Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
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1912954090 | New Hanover Community Health Center Incorporated | Clinic/Center | 925 N 4th St, Wilmington, NC 28401-3450 | 2006-05-27 |
1952303695 | Westside Family Healthcare, Inc. | Clinic/Center | 908 E 16th St Ste B, Wilmington, DE 19802-5145 | 2005-08-12 |
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1497071161 | La Red Health Center, Inc. | Clinic/Center | 300 High St, Seaford, DE 19973-3940 | 2010-04-20 |
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1225163199 | Delmarva Rural Ministries, Inc. | Clinic/Center | 26 Wyoming Ave, Dover, DE 19904-6922 | 2007-02-22 |
1801898556 | Westside Family Healthcare, Inc | Clinic/Center | 27 Marrows Rd, Newark, DE 19713-3701 | 2005-08-12 |
City | WILMINGTON |
Zip Code | 19801 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.