Antietam Family Health, Llc
LBN: Antietam Family Health, Llc
Antietam Family Health, Llc is an health care organization with primary practice located at 1101 Opal Ct Ste 217 , Hagerstown MD 21740-5941. The organization recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Family is the primary health care specialty.
Antietam Family Health, Llc can be contacted via phone (240) 203-8864, or through Roncone, Mark Anthony via phone (240) 203-8864.
Contact Information
Primary practice address
1101 Opal Ct Ste 217
Hagerstown MD 21740-5941
Phone: (240) 203-8864
Fax: (240) 866-8173
Website:
Authorized official contact:
Name: Roncone, Mark Anthony Family Nurse Practitioner (FNP)
Phone: (240) 203-8864
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X |
Profile Details
| NPI number | 1548972318 |
|---|---|
| LBN Legal business name | Antietam Family Health, Llc |
| DBA Doing business as | |
| Authorized official | Roncone, Mark Anthony Family Nurse Practitioner (FNP) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Dec 23rd, 2022 |
| Last updated | Sep 8th, 2023 - about last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548972318 | NPPES |
| Maryland | MEDICAID | 287005300 | |
| Maryland | MEDICAID | 319064100 |
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