| Organization Name: | GREATER BADEN MEDICAL SERVICE INCORPORATED |
| NPI Number: | 1275783615 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | COLENTHIA A MALLOY (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 1458 Addison Rd S Capitol Heights |
| State: | MD US |
| Postal Code: | 207434413 |
| Phone Number: | 3013241500 |
| Fax Number: | 3013246405 |
| NPI Enumeration Date: | 09/23/2008 |
| NPI Last Update Date: | 02/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |