NPI 1619122504

Prevention &management Outreach Clinic INC.

Organisation Preferred Provider Organization Columbia, MD

Practice location

Address: 5941 Millrace CT Unit D103, Columbia, MD 21045-7204
Phone: (410) 312-3126

Authorised official

Name: Lisa Bush
Title: President/Ceo
Phone: (410) 312-3126

Registered specialties (4)

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

Other Preferred Provider Organization providers in Maryland →

Preferred Provider Organization

Managed Care Organizations Taxonomy 305R00000X

Preferred Provider Organization

Managed Care Organizations Taxonomy 305R00000X Licence 0000000000 (MD)

Preferred Provider Organization

Managed Care Organizations Taxonomy 305R00000X Licence 30500000X (MD)

Registry record

NPI: 1619122504
Entity type: Organization
NPI issued: 19 Nov 2008
Record last updated: 19 Nov 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.