Henrietta Johnson Medical Center
LBN: Southbridge Medical Advisory Council Inc
Henrietta Johnson Medical Center is an health care organization with primary practice located at 601 New Castle Ave , Wilmington DE 19801. The organization recently has 4 registered licenses in different health care specialties including Dental Providers / Dentist, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Gynecology, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC). Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty.
Southbridge Medical Advisory Council Inc can be contacted via phone (302) 655-6187, or through Rivera, Rosa V via phone (302) 655-6187.
Contact Information
Primary practice address
601 New Castle Ave
Wilmington DE 19801
Phone: (302) 655-6187
Fax: (302) 655-6606
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | ||
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ||
| Allopathic & Osteopathic Physicians / Gynecology | 207VG0400X | ||
| Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) | 261QF0400X |
Profile Details
| NPI number | 1770699621 |
|---|---|
| LBN Legal business name | Southbridge Medical Advisory Council Inc |
| DBA Doing business as | Henrietta Johnson Medical Center |
| Authorized official | Rivera, Rosa V |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Aug 22nd, 2006 |
| Last updated | Jan 16th, 2013 - about 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770699621 | NPPES |
| Other | 458117 | TRAIL BLAZER | |
| MEDICAID | 0000332866 | TRAIL BLAZER |
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