1174769822 NPI number — GROUP MAIN STREAM INC.

Table of content: (NPI 1174769822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174769822 NPI number — GROUP MAIN STREAM INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROUP MAIN STREAM INC.
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:
GMS
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:
1174769822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 SAUNDERS WAY
Provider Second Line Business Mailing Address:
SUITE 500G
Provider Business Mailing Address City Name:
WESTBROOK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04092-4833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-523-5170
Provider Business Mailing Address Fax Number:
207-854-1787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 SAUNDERS WAY
Provider Second Line Business Practice Location Address:
SUITE 500G
Provider Business Practice Location Address City Name:
WESTBROOK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04092-4833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-523-5170
Provider Business Practice Location Address Fax Number:
207-854-1787
Provider Enumeration Date:
12/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MACMAHAN
Authorized Official First Name:
DOREEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
207-523-5170

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  ALLS3183 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: ALLS2704 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: ALLS2699 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320900000X , with the licence number: ALLS2706 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: ALLS3093 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: ALLS3094 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: ALLS3206 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 111150003 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111150002 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111150001 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111150006 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111150000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111150004 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111150005 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com