1003993627 NPI number — DR. AMY MOONEY LEWELLEN D.C.

Table of content: DR. AMY MOONEY LEWELLEN D.C. (NPI 1003993627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003993627 NPI number — DR. AMY MOONEY LEWELLEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWELLEN
Provider First Name:
AMY
Provider Middle Name:
MOONEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOONEY
Provider Other First Name:
AMY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003993627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 COVE ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-828-8777
Provider Business Mailing Address Fax Number:
207-828-8778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 COVE ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-828-8777
Provider Business Practice Location Address Fax Number:
207-828-8778
Provider Enumeration Date:
11/01/2006

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: 111N00000X , with the licence number:  2455 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: CR1393 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1049468 . This is a "ASHN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4402698 . This is a "ACN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 022182 . This is a "ANTHEM BCBS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2146577 . This is a "FIRST HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 351399 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003993627 . This is a "MEDCARE PTAN UX2254" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: Y36775 . This is a "BLUECROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0630793200 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2503521 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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