1073735676 NPI number — TONW OF HERMON - SCHOOL DEPARTMENT

Table of content: (NPI 1073735676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073735676 NPI number — TONW OF HERMON - SCHOOL DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TONW OF HERMON - SCHOOL DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073735676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04402-6360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-848-4000
Provider Business Mailing Address Fax Number:
207-848-5226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 BILLINGS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-848-4000
Provider Business Practice Location Address Fax Number:
207-848-5226
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DURAN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
207-848-4000

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  251300000X , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 136660000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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