Organization · Type 2 NPI

Civista Clinical Services LLC

Multi-Specialty Clinic/Center · Waldorf, MD

NPI number 1831417476 Active

Practice location

11315 Pembrooke Sq Ste 111
Waldorf, MD 20603-4806

Call (301) 843-3150 Map

Fax (301) 843-2560

Mailing address

5 Garrett Avenue, PO Box 1070
La Plata, MD 20646-1070

Specialties and licenses

Taxonomy	Code	License
Multi-Specialty Clinic/Center Primary	261QM1300X	D0065304 (MD)

Multi-Specialty Clinic/Center: Definition to come...

Another provider at this address

Shawnee Lakai Thomas, CRNPFamily Nurse Practitioner Waldorf, MD NPI 1952814204

Other multi-specialty clinic/center providers in Waldorf

Total Health Medical Center, PCMulti-Specialty Clinic/Center Waldorf, MD NPI 1063603777

See all in Waldorf →

NPI record

NPI: 1831417476
Entity type: Organization (Type 2)
Issued: May 6, 2010
Last updated: Dec 17, 2019
Status: Active
Subpart: Yes of Civista Medical Center

Other names

<unavail>
Civista Women's Health Center · doing business as
Civista Women's Health Center · doing business as

Authorized official

Mrs. Ivette M Montes de Oca
Practice Manager
(301) 843-3150

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1831417476

Civista Clinical Services LLC's National Provider Identifier is 1831417476, issued on May 6, 2010. The primary taxonomy on file is Multi-Specialty Clinic/Center (261QM1300X), and the practice location is in Waldorf, MD. The record was last updated on Dec 17, 2019.