TIDALHEALTH PRIMARY CARE, LLC
Complete NPI Record 1104453208
Family Medicine in Salisbury, MD
Active since March 26, 2020CLIA Certified · 7 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Tidalhealth Primary Care, Llc (NPI 1104453208), a family medicine organization in Salisbury, MD. All 32 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1104453208 Field 1/32
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/32
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/32
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: TIDALHEALTH PRIMARY CARE, LLC Field 4/32
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/32
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/32
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 100 E CARROLL ST Field 7/32
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: SALISBURY Field 8/32
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MD Field 9/32
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 218015422 Field 10/32
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/32
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 4109124976 Field 12/32
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 4109124972 Field 13/32
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 100 E CARROLL ST Field 14/32
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: SALISBURY Field 15/32
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MD Field 16/32
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 218015422 Field 17/32
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/32
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 4105466400 Field 19/32
- The telephone number associated with the location address of the provider being identified.
- Authorized Official Last Name: PELOT Field 22/32
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: WILLIAM Field 23/32
- The first name of the authorized official.
- Authorized Official Title or Position: CHIEF ADMINISTRATOR OFFICER Field 24/32
- The title or position of the authorized official.
- Authorized Official Telephone Number: 4105437497 Field 25/32
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 261QC1500X Field 26/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 27/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 207Q00000X Field 28/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: Y Field 29/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 30/32
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 2: 193400000X SINGLE SPECIALTY GROUP Field 31/32
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
TidalHealth Community Wellness Other Name
Name 1/1Other Name: Any additional name associated with either an individual provider or an organization that does not fall under the other defined name type categories.
Secondary Practice Locations 9
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
30265 Commerce Dr, Suite 206
Location 1/9Millsboro, DE 19966-3595 · Phone (302) 732-8400 · Fax (302) 934-6705
100 E Carroll St
Location 2/9Salisbury, MD 21801-5422 · Phone (410) 912-6400
201 Hall Hwy
Location 3/9Crisfield, MD 21817-1237 · Phone (410) 968-1801 · Fax (410) 968-1015
305 10th St Ste 101
Location 4/9Pocomoke City, MD 21851-1607 · Phone (410) 912-4950
9950 N Main St
Location 5/9Berlin, MD 21811-1076 · Phone (410) 912-6710
428 W Market St
Location 6/9Snow Hill, MD 21863-1127 · Phone (410) 912-4950 · Fax (410) 632-2284
145 E Carroll St
Location 7/9Salisbury, MD 21801-5454 · Phone (410) 912-5785 · Fax (410) 912-3616
11101 Cathage Rd
Location 8/9Ocean Pines, MD 21811-2115 · Phone (410) 912-6104 · Fax (410) 208-1872
1639 Woodbrooke Dr
Location 9/9Salisbury, MD 21804-8502 · Phone (410) 912-5785
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