Wildewood Medical Care

LBN: John Scott Tidball, Md, Pc
Wildewood Medical Care is an health care organization with primary practice located at 23415 Three Notch Rd Ste 2054 Wildewood Ctr, California MD 20619-4017. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. John Scott Tidball, Md, Pc can be contacted via phone (301) 737-7833, or through Tidball, John Scott via phone (301) 737-7833.

Contact Information

Primary practice address
23415 Three Notch Rd Ste 2054 Wildewood Ctr California MD 20619-4017
Phone: (301) 737-7833
Fax: (301) 737-4865
Website:
Map and Directions
Authorized official contact:
Name: Tidball, John Scott Doctor of Medicine (MD)
Phone: (301) 737-7833

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X D52196 Maryland

Profile Details

NPI number 1770659609
LBN Legal business name John Scott Tidball, Md, Pc
DBA Doing business as Wildewood Medical Care
Authorized official Tidball, John Scott Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 24th, 2006
Last updated Apr 4th, 2011 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770659609 NPPES
Maryland MEDICAID 138950500

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