1669450524 NPI number — KATAHDIN VALLEY HEALTH CENTER

Table of content: (NPI 1669450524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669450524 NPI number — KATAHDIN VALLEY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATAHDIN VALLEY HEALTH CENTER
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:
1669450524
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
529 S PATTEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATTEN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04765-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-528-2285
Provider Business Mailing Address Fax Number:
207-528-2880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 HOULTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATTEN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04765-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-528-2285
Provider Business Practice Location Address Fax Number:
207-528-2880
Provider Enumeration Date:
01/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUMPHREY
Authorized Official First Name:
CLAUDETTE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
207-528-2285

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 030175 . This is a "ANTHEM GROUP" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 144828 . This is a "AETNA GROUP" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 168260100 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".