1700125267 NPI number — MAINE VETERANS' HOMES

Table of content: (NPI 1700125267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700125267 NPI number — MAINE VETERANS' HOMES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINE VETERANS' HOMES
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:
MVH PHARMACY (EXTERNAL NON VA BUSINESS)
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:
1700125267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 COMMUNITY DR
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04330-8087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-624-0200
Provider Business Mailing Address Fax Number:
207-624-0201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 CIVIC CENTER DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04330-7902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-624-0200
Provider Business Practice Location Address Fax Number:
207-624-0201
Provider Enumeration Date:
02/04/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCQUAID
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
207-622-0075

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PH50001457 , 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: 2008743 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".