Provider Demographics
NPI:1174893556
Name:QUEEN ANNE'S COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:QUEEN ANNE'S COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:410-758-1306
Mailing Address - Street 1:206 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-1049
Mailing Address - Country:US
Mailing Address - Phone:410-758-1306
Mailing Address - Fax:410-758-2133
Practice Address - Street 1:205 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1022
Practice Address - Country:US
Practice Address - Phone:410-758-1306
Practice Address - Fax:410-758-2133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEEN ANNE'S COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-03
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD750325261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420917600OtherJAI MEDICAL MA MCO
MD420917600OtherUNITED HEALTH CARE-MA MCO
MD01372281OtherAMERIGROUP MA MCO
MD420917600OtherMARYLAND PHYSICIANS CARE MA MCO
MD019364OtherRIVERSIDE MA MCO
MD019364OtherVALUE OPTIONS MA MCO
MD056064OtherPRIORITY PARTNERS PAC MCO
MDH93OtherCAREFIRST BCBS OF MD
MD01372281OtherAMERIGROUP PAC MCO
MD420917600OtherDIAMOND PLAN MA MCO
MD420917600OtherUNITED BEHAVIORAL HEALTH MA MCO
MD056064OtherPRIORITY PARTNERS MA MCO
MD420917600OtherMEDSTAR FAMILY MA MCO
MD420917600Medicaid
MD056064OtherPRIORITY PARTNERS PAC MCO