1407142649 NPI number — EAST RANGE II

Table of content: LAURIE S MCMANUS FNP (NPI 1548246614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407142649 NPI number — EAST RANGE II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST RANGE II
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:
6
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:
1407142649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 580
Provider Second Line Business Mailing Address:
63 BROADWAY STREET
Provider Business Mailing Address City Name:
BAILEYVILLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04694-0580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-427-6038
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 HOULTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANFORTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04424-3138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-427-6038
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCLAUGHLIN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
207-427-6038

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: 100760537 . This is a "DUNS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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