1528005576 NPI number — MR. RICHARD FREDERICK BOYD R.N., C.R.N.A.

Table of content: DR. GREGORY A LEWIS M.D. (NPI 1023098910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528005576 NPI number — MR. RICHARD FREDERICK BOYD R.N., C.R.N.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
RICHARD
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.N., C.R.N.A.
Provider Gender Code:
M

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:
1528005576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 EPPS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEAKS ISLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04108-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-766-3050
Provider Business Mailing Address Fax Number:
207-766-3050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 EPPS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEAKS ISLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04108-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-766-3050
Provider Business Practice Location Address Fax Number:
207-766-3050
Provider Enumeration Date:
05/31/2006

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: 367500000X , with the licence number:  R018347 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: CR000611 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 100853 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 0024167006 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R018347 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: AA083210 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 058929-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 44344000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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