1326132218 NPI number — CITY OF BANGOR

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326132218 NPI number — CITY OF BANGOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BANGOR
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:
BANGOR HEALTH & COMMUNITY SERVICES
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:
1326132218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 TEXAS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-992-4547
Provider Business Mailing Address Fax Number:
207-992-9161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 TEXAS AVE
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:
04401-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-992-4531
Provider Business Practice Location Address Fax Number:
207-945-3348
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PUBLIC HEALTH NURSING
Authorized Official Telephone Number:
207-992-4550

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  25100000X , 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: 135940700 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135410400 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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