1770512618 NPI number — MS. LORI A PRESTON CRNA

Table of content: MS. LORI A PRESTON CRNA (NPI 1770512618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770512618 NPI number — MS. LORI A PRESTON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESTON
Provider First Name:
LORI
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1770512618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301C US ROUTE ONE
Provider Second Line Business Mailing Address:
MAINE MEDICAL PARTNERS
Provider Business Mailing Address City Name:
SCARBOROUGH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-396-8600
Provider Business Mailing Address Fax Number:
740-446-5982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 MILES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAMARISCOTTA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04543-4047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-563-4837
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2006

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:  50684 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 19248 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: RNA143018 , 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: 1770512618 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001706470 . This is a "MSBCBS GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0069300000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2058204 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA0096 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2460484 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001720720 . This is a "MSBCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2460484 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27005299700 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00794072 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 001720720 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0207026000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27005299700 . This is a "WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 270052997003 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00273112 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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