1205936606 NPI number — JOANNE REINIGER PAC

Table of content: JOANNE REINIGER PAC (NPI 1205936606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205936606 NPI number — JOANNE REINIGER PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINIGER
Provider First Name:
JOANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

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:
1205936606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
891 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DOVER FOXCROFT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04426-1059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-564-4464
Provider Business Mailing Address Fax Number:
207-564-4461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
891 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DOVER FOXCROFT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04426-1059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-564-4464
Provider Business Practice Location Address Fax Number:
207-564-4461
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA001147 , 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: 433249099 . This is a "MAINECARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: P00671913 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 0008729 . This is a "MEDICARE PTAN" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 000872901 . This is a "MEDICARE PTAN FOR DEXTER FAMILY HEALTH" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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