# CIVISTA CLINICAL SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CIVISTA MEDICAL CENTER
- **Other names:** Civista Women's Health Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1831417476
- **Legal business name:** CIVISTA MEDICAL CENTER
- **Authorized official:** MRS. IVETTE M MONTES DE OCA (PRACTICE MANAGER)
- **Authorized official phone:** (301) 843-3150

## Contact information

- **Practice address:** 11315 PEMBROOKE SQ STE 111, WALDORF, MD 20603-4806
- **Practice address phone:** (301) 843-3150
- **Practice address fax:** (301) 843-2560
- **Mailing address:** 5 GARRETT AVENUE, PO BOX 1070, LA PLATA, MD 20646-1070
- **Mailing address phone:** (301) 609-4000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | D0065304 | MD | Yes |

## Other

- **Enumeration date:** 05/06/2010
- **Last updated:** 12/17/2019