1952500092 NPI number — NEW HEALTH P A

Table of content: (NPI 1952500092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952500092 NPI number — NEW HEALTH P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HEALTH P A
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:
1952500092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 CHAPMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWER
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04412-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-478-6506
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 CHAPMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWER
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04412-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-478-6506
Provider Business Practice Location Address Fax Number:
978-225-2251
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TARDY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
DENNIS
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
207-478-6506

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  PT1060 , 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: 048932 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 260240000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3662706 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1393159 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com