1275845604 NPI number — INLAND FAMILY PRACTICE ASSOCIATES,LLC

Table of content: (NPI 1275845604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275845604 NPI number — INLAND FAMILY PRACTICE ASSOCIATES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INLAND FAMILY PRACTICE ASSOCIATES,LLC
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:
THE CLINIC AT WALMART
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:
1275845604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 KENNEDY MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERVILLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04901-4526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-395-0232
Provider Business Mailing Address Fax Number:
207-873-2385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 WATERVILLE COMMONS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-680-2110
Provider Business Practice Location Address Fax Number:
207-680-2114
Provider Enumeration Date:
07/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BITHER
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
V.P. FINANCE
Authorized Official Telephone Number:
207-861-3000

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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