Provider Demographics
NPI:1730254681
Name:KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES,INC
Entity type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-257-2797
Mailing Address - Street 1:4000 GARDEN CITY DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2418
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:4000 GARDEN CITY DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2418
Practice Address - Country:US
Practice Address - Phone:301-816-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD306728OtherMEDICARE GROUP ID
DC410092OtherMEDICARE GROUP ID
MDK679OtherMEDICARE GROUP ID
VAA00073OtherMEDICARE GROUP ID
VAC08232OtherMEDICARE GROUP ID
MDG01288OtherMEDICARE GROUP ID
MDS883OtherMEDICARE GROUP ID
DE410092Medicare PIN
DC410092Medicare PIN
VAC08232OtherMEDICARE GROUP ID
MDK679OtherMEDICARE GROUP ID
VAC08232Medicare PIN
MDK679Medicare PIN
MDG01288OtherMEDICARE GROUP ID
DC410092OtherMEDICARE GROUP ID