1154321545 NPI number — ST. JOSEPH HOSPITAL

Table of content: (NPI 1154321545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154321545 NPI number — ST. JOSEPH HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOSEPH 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:
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:
1154321545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95000 LBX 7620
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-777-8202
Provider Business Mailing Address Fax Number:
207-783-6660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-3979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-907-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDRIX
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
207-907-1600

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  38869 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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