1750836656 NPI number — SOUTHERN MAINE HEALTH CARE

Table of content: (NPI 1750836656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750836656 NPI number — SOUTHERN MAINE HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MAINE HEALTH CARE
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:
SMHC SANFORD WALK IN CARE
Provider Other Organization Name Type Code:
5
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:
1750836656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIDDEFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04005-9422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-283-7000
Provider Business Mailing Address Fax Number:
207-283-7063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25A JUNE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04073-2642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-283-7000
Provider Business Practice Location Address Fax Number:
207-283-7063
Provider Enumeration Date:
08/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BELAIR
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
SENIOR VP/CFO
Authorized Official Telephone Number:
207-283-7898

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  38427 , 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)





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