1215269626 NPI number — MAINE MEDICAL PARTNERS

Table of content: (NPI 1215269626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215269626 NPI number — MAINE MEDICAL PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINE MEDICAL PARTNERS
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:
MAINE MEDICAL PARTNERS NEUROLOGY
Provider Other Organization Name Type Code:
3
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:
1215269626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SOUTHBOROUGH DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SOUTH PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04106-6914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-661-2000
Provider Business Mailing Address Fax Number:
207-661-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 CAMPUS DRIVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
SCARBOROUGH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-883-1414
Provider Business Practice Location Address Fax Number:
207-883-1010
Provider Enumeration Date:
02/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JAUREGUI
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR-PRVDR ENROLLMENT & CVO, MHMG PA
Authorized Official Telephone Number:
207-661-5414

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0402X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084V0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085D0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471M1202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 30218004 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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