BRANCH MEDICAL CLINIC INDIAN HEAD (NPI# 1841498417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841498417 |
| Entity Type | Organization |
| Organization Name | BRANCH MEDICAL CLINIC INDIAN HEAD |
| Practice Address |
4141 W Wilson Rd Suite105 Indian Head MD 20640-5162 |
| Practice Telephone | 3017444601 |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2017-12-19 |
| Authorized Official Name | MR. WILLIAM MICHAEL CONDON (NAVY MEDICINE UBO PROGRAM MANAGER) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | NAVAL HEALTH CLINIC PATUXENT RIVER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| Street Address |
4141 W WILSON RD SUITE105 |
| City | INDIAN HEAD |
| State | MD |
| Zip Code | 20640-5162 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659616837 | Jason Richard Palmer | Physician Assistant | 4141 W Wilson Rd, Bldg 1600, Indian Head, MD 20640-5162 | 2012-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639664683 | The Heard Group, LLC | Clinic/Center | 6284 Hard Bargain Cir, Indian Head, MD 20640 | 2018-06-22 |
| 1154790509 | Memuna Kamara | Nurse Practitioner | 319 Munahan Circle Unit A, Indian Head, MD 20640 | 2015-09-16 |
| 1174620926 | Naval Health Clinic Patuxent River | Military/U.S. Coast Guard Pharmacy | Bldg 1600 Wilson Drive, Indian Head, MD 20640 | 2006-09-20 |
| 1861494395 | Dale R Harman | Preventive Medicine | 1600 W Wilson Rd, Occupational Health Clinic, Nswc Indian Head, Indian Head, MD 20640-1400 | 2005-08-15 |
| 1467414508 | Keith Lynn Mayberry | Dentist | 1600 W Wilson Rd, Indian Head, MD 20640-1400 | 2006-04-04 |
| 1588646962 | John H Callahan | Physician Assistant | 17 Strauss Ave, Indian Head Division, Indian Head, MD 20640-1523 | 2005-11-18 |
| 1114064573 | Monica L Bilik | Physician Assistant | 101 Strauss Ave Bldg 901, Indian Head, MD 20640-1542 | 2007-02-01 |
| 1881654697 | Kevin F Kelley Sr. | Physician Assistant | 101 Strauss Ave, Cbirf, 2nd Mef, Indian Head, MD 20640-1542 | 2006-03-24 |
| 1750561189 | Dexter Arvange Woods | Dentist | 158 Riverwatch Dr, Indian Head, MD 20640-1558 | 2007-11-14 |
| 1649818907 | Augustina O Boadu | Non-emergency Medical Transport (VAN) | 32 Fairhill Ln, Indian Head, MD 20640-1577 | 2019-12-18 |
| Find all providers in zip 20640 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033315080 | Branch Medical Clinic Bancroft Hall | Clinic/Center | 121 Blake Rd, Annapolis, MD 21402-1300 | 2007-06-26 |
| 1063959450 | Uscg Clinic Baltimore | Clinic/Center | 2401 Hawkins Point Rd, Curtis Bay, MD 21226-1797 | 2017-01-24 |
| 1043668775 | Logistics Health Incorporated | Clinic/Center | 4201 Northview Dr Ste 410, Bowie, MD 20716-2668 | 2016-06-03 |
| 1811228422 | Us Coast Guard | Clinic/Center | 2401 Hawkins Point Rd, Baltimore, MD 21226-1797 | 2010-01-21 |
| 1851622401 | Us Coast Guard Yard - Hswl Clinic | Clinic/Center | 2401 Hawkins Point Rd, Bldg 28b, Baltimore, MD 21226 | 2010-01-21 |
| 1487850541 | Branch Medical Clinic Andrews | Clinic/Center | 1 San Diego Loop, Bldg 3282, Andrews Afb, MD 20762-5518 | 2007-06-26 |
| 1316142607 | Kimbrough Acc Military Mtf | Clinic/Center | 1434 Porter St, Usadc, Fort Detrick, MD 21702-9210 | 2007-06-18 |
| 1093910374 | Kimbrough Acc Military Mtf | Clinic/Center | 4110 Austin Road, Aberdeen Proving Ground, MD 21010 | 2007-06-18 |
| 1689879926 | Kimbrough Acc Military Mtf | Clinic/Center | 2501 Oakington St, Aberdeen Proving Ground, MD 21005-5131 | 2007-06-18 |
| 1124223797 | Kimbrough Acc Military Mtf | Clinic/Center | 8472 Simmond St, Fort Meade, MD 20755-5700 | 2007-06-15 |
| Find all providers with the same taxonomy | ||||
| City | INDIAN HEAD |
| Zip Code | 20640 |
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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.