1902997299 NPI number — SALMON FALLS PATHOLOGY LLC

Table of content: (NPI 1902997299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902997299 NPI number — SALMON FALLS PATHOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
SALMON FALLS PATHOLOGY LLC
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:
SALMON FALLS PATHOLOGY PA
Provider Other Organization Name Type Code:
4
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:
1902997299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1849
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04241-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-784-2554
Provider Business Mailing Address Fax Number:
207-777-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 WHITEHALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-335-8195
Provider Business Practice Location Address Fax Number:
603-330-0098
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAPLE
Authorized Official First Name:
JOCELYN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-332-7303

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30008982 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 604295100 . This is a "FED WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 142720000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9757881 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 607638 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".