1073753927 NPI number — MAINE HOSPITALIST SERVICE, INC

Table of content: (NPI 1073753927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073753927 NPI number — MAINE HOSPITALIST SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINE HOSPITALIST SERVICE, INC
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:
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:
1073753927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 WALLACE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04106-6143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-761-0650
Provider Business Mailing Address Fax Number:
207-761-8198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 BRAMHALL ST
Provider Second Line Business Practice Location Address:
PAVILION 1203
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-662-4618
Provider Business Practice Location Address Fax Number:
207-662-6254
Provider Enumeration Date:
03/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BATES
Authorized Official First Name:
PETER
Authorized Official Middle Name:
W
Authorized Official Title or Position:
VP MEDICAL AFFAIRS & CMO
Authorized Official Telephone Number:
207-662-2776

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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