1164611703 NPI number — LIANE MULLER, D.O., PA

Table of content: DR. RODNEY M SWENSON D.O. (NPI 1407863913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164611703 NPI number — LIANE MULLER, D.O., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIANE MULLER, D.O., PA
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:
1164611703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04009-0118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-647-2440
Provider Business Mailing Address Fax Number:
207-647-3775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BRIDGTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-647-2440
Provider Business Practice Location Address Fax Number:
207-647-3775
Provider Enumeration Date:
10/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MULLER
Authorized Official First Name:
LIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
207-647-2440

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1869 , 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: 1127587 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 099629 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431995900 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: I33516 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5488624 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com