1851423008 NPI number — EASTERN MAINE HEALTHCARE SYSTEMS INLAND HOSPITAL

Table of content: (NPI 1851423008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851423008 NPI number — EASTERN MAINE HEALTHCARE SYSTEMS INLAND HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN MAINE HEALTHCARE SYSTEMS INLAND HOSPITAL
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:
INLAND FAMILY CARE - MADISON/SKOWHEGAN
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:
1851423008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 756
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOWHEGAN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04976-0756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-474-2994
Provider Business Mailing Address Fax Number:
207-858-0201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 LAKEWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04950-3015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-474-2994
Provider Business Practice Location Address Fax Number:
207-858-0201
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABBOTT
Authorized Official First Name:
BETSY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
207-861-3338

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116010201 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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