1265422943 NPI number — KRISTINA CHADWICK PA-C

Table of content: KRISTINA CHADWICK PA-C (NPI 1265422943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265422943 NPI number — KRISTINA CHADWICK PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHADWICK
Provider First Name:
KRISTINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROLLENDER
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265422943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04240-7027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-795-0111
Provider Business Mailing Address Fax Number:
207-795-7133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240-7027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-795-0111
Provider Business Practice Location Address Fax Number:
207-795-7133
Provider Enumeration Date:
10/25/2005

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: 363A00000X , with the licence number:  PA631 , 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: 010416156 . This is a "CIGNA / GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201017 . This is a "MEDICARE ASC FACILITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 261500099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: MM0716 . This is a "MEDICARE CLINIC FACILITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010416156 . This is a "CORE / MEDNET / TRAVELERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0378600001 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP1070 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 025716 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100294000 . This is a "USPS WC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 970026374 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1044480 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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