1154430023 NPI number — JANE G. ADAMS APRN-BC

Table of content: JANE G. ADAMS APRN-BC (NPI 1154430023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154430023 NPI number — JANE G. ADAMS APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
JANE
Provider Middle Name:
G.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC
Provider Gender Code:
F

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:
1154430023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 HOSPITAL DR
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
03909-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-351-2478
Provider Business Mailing Address Fax Number:
207-351-2153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 SANFORD RD
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
WELLS
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04090-5533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-641-8044
Provider Business Practice Location Address Fax Number:
207-854-1516
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  048539 , 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: 010212444 . This is a "TAX ID #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1699860270 . This is a "GROUP NPI #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 432036099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100142 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1154430023 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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