KIMBROUGH AMBULATORY CARE CENTER (NPI# 1265596951) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265596951 |
| Entity Type | Organization |
| Organization Name | KIMBROUGH AMBULATORY CARE CENTER |
| Practice Address |
2480 Llewellyn Ave Fort Meade MD 20755-5800 |
| Practice Telephone | 3016778586 |
| Mailing Telephone | 3016778586 |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. NAHIDA HADEESH (CLINICAL SOCIAL WORKER) |
| Authorized Official Telephone | 3016778586 |
| Authorized Official Credential | LICSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
LC302917 | DC | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487885547 | Kimbrough Ambulatory Care Center | Clinic/Center | 2480 Llewellyn Ave, Fort Meade, MD 20755-7081 | 2009-08-06 |
| 1649320276 | Kimbrough Ambulatory Care Center | Clinic/Center | 2480 Llewellyn Ave, Fort Meade, MD 20755-5800 | 2007-01-12 |
| 1679622658 | Kimbrough Ambulatory Care Center | Nursing Facility/Intermediate Care Facility | 2480 Llewellyn Ave, Fort George G Meade, MD 20755-5800 | 2007-01-09 |
| Street Address |
2480 LLEWELLYN AVE |
| City | FORT MEADE |
| State | MD |
| Zip Code | 20755-5800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356802524 | Lindsay Marie Robinson | Physical Therapy Assistant | 2480 Llewellyn Ave, Fort Meade, MD 20755-7081 | 2019-03-28 |
| 1346742905 | Judy Garcia De Cubias | Occupational Therapy Assistant | 2480 Llewellyn Ave, Fort Meade, MD 20755-7081 | 2018-02-28 |
| 1760926463 | Patrice Sahvohn Scott | Social Worker | 2480 Llewellyn Ave, Ste. 5800, Fort Meade, MD 20755-7081 | 2016-12-14 |
| 1518417815 | Mikala Bruno | Physical Therapist | 2480 Llewellyn Ave, Fort Meade, MD 20755-7081 | 2016-10-11 |
| 1386091254 | Kelly Rae Turner | Physician Assistant | 2480 Llewellyn Ave, Fort Meade, MD 20755-7081 | 2016-05-19 |
| 1255735403 | Christine Ng | Pharmacist | 2480 Llewellyn Ave, Fort Meade, MD 20755-7081 | 2014-10-17 |
| 1336541978 | Ella Maria Stallings | Nurse Practitioner | 2480 Llewellyn Ave, Fort Meade, MD 20755 | 2014-09-25 |
| 1588005052 | Christine Tuong-vi Nguyen Darby | Pharmacist | 2480 Llewellyn Ave, Fort Meade, MD 20755-7081 | 2013-07-12 |
| 1285989525 | Marian G Upton | Counselor | 2480 Llewellyn Ave, Fort Meade, MD 20755-7081 | 2012-07-23 |
| 1578827325 | Tracy Viviansue Love | Dermatology | 2480 Llewellyn Ave, Fort Meade, MD 20755-7081 | 2012-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215451216 | Patrick Hoye | Dentist | 8472 Simonds Street, Epes Dental Clinic, Ft. Meade, MD 20755 | 2017-08-01 |
| 1982150561 | Martha Davis | Technician | 2553 Hartel St, Fort Meade, MD 20755 | 2016-09-01 |
| 1649725995 | Jaclyn Leith | Psychologist | 2479 5th St., Ft. Meade, MD 20755 | 2016-08-16 |
| 1548613417 | Catherine Geller | Dental Hygienist | 8476 Simonds St, Suite 5700, Fort George G. Meade, MD 20755 | 2016-07-15 |
| 1396194510 | Cristina Ribeiro | Dental Hygienist | 8476 Simond St, Suite 5700, Fort George G. Meade, MD 20755 | 2016-06-08 |
| 1508215765 | Nicole Ferris | Dental Hygienist | 8476 Simond St Ste 5700, Fort George G. Meade, MD 20755 | 2016-06-08 |
| 1487031548 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | Rose Street, Bldg 2799, Ft Meade, MD 20755 | 2015-04-28 |
| 1801206685 | Kimbrough Acc Military Mtf | Pharmacy | 2799 Rose Street, Ft Meade, MD 20755 | 2014-05-02 |
| 1578980744 | Claudia Goleburn | Psychologist | 2479 5th St, Ft Meade, MD 20755 | 2014-03-25 |
| 1093063158 | Michael Elsworth Yapp | Pharmacist | 24180 Llewellyn Avenue, Fort Meade, MD 20755 | 2012-08-21 |
| Find all providers in zip 20755 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| 1801402656 | Desicare LLC | Clinic/Center | 7712 West Shore Road, Pasadena, MD 21122-1519 | 2020-09-17 |
| 1508472226 | Resilient Psychiatry, LLC | Clinic/Center | 744 Dulaney Valley Rd Ste 7, Towson, MD 21204-5132 | 2020-09-17 |
| 1356955298 | Peace In Perspective | Clinic/Center | 11 Far Corners Loop, Sparks, MD 21152-9256 | 2020-09-08 |
| Find all providers with the same taxonomy | ||||
| City | FORT MEADE |
| Zip Code | 20755 |
Please comment or provide details below to improve the information on KIMBROUGH AMBULATORY CARE CENTER.
| 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.