1487896080 NPI number — CITY OF PORTLAND MAINE

Table of content: MARK SCHERING JENKINS MD (NPI 1376592469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487896080 NPI number — CITY OF PORTLAND MAINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF PORTLAND MAINE
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:
1487896080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
389 CONGRESS ST
Provider Second Line Business Mailing Address:
ROOM 307
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101-3566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-874-8784
Provider Business Mailing Address Fax Number:
207-874-8913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 BRACKETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102-3825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-874-8786
Provider Business Practice Location Address Fax Number:
208-874-8447
Provider Enumeration Date:
03/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JENNINGS
Authorized Official First Name:
JON
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CITY MANAGER
Authorized Official Telephone Number:
207-874-8689

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 136040603 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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