| NPI | 1104453208 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2020-03-26 |
| Last Updated | 2025-07-22 |
| Authorized Official | William Pelot Chief Administrator Officer Phone: 4105437497 |
| Mailing Address | 100 E Carroll St Salisbury, MD 21801-5422 United States Phone: (410) 912-4976 | Fax: (410) 912-4972 📍 View Map |
| Primary Practice Address | 100 E Carroll St Salisbury, MD 21801-5422 United States Phone: (410) 546-6400 📍 View Map |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| No | 261QC1500X – Clinic/Center, Community Health | — | — |
| Yes | 207Q00000X – Family Medicine | — | — |
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About NPI 1104453208
Tidalhealth Primary Care, Llc is an organization registered in the CMS NPPES NPI Registry with NPI number 1104453208. The primary specialty listed is Family Medicine. The organization is located in Salisbury, MD. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2020-03-26. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1104453208?
NPI 1104453208 belongs to Tidalhealth Primary Care, Llc, a Family Medicine in Salisbury, MD. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1104453208 active?
The current status of NPI 1104453208 in the NPPES registry is Active. The record was last updated on 2025-07-22.
What specialty is NPI 1104453208?
NPI 1104453208 is classified under the taxonomy Family Medicine. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1104453208?
You can verify NPI 1104453208 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1104453208?
The primary practice address on file for NPI 1104453208 is 100 E Carroll St, Salisbury, MD 21801-5422. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1104453208 issued?
NPI 1104453208 was first issued (enumerated) on 2020-03-26. The NPPES record was last updated on 2025-07-22.
Practice Location Map
Tidalhealth Primary Care, Llc is located at 100 E Carroll St, Salisbury, MD. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Tidalhealth Primary Care, Llc. All records sourced from the CMS NPPES registry.