1164649349 NPI number — CITY OF AUGUSTA

Table of content: (NPI 1164649349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164649349 NPI number — CITY OF AUGUSTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF AUGUSTA
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:
6
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:
1164649349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 GEDNEY ST
Provider Second Line Business Mailing Address:
SUPERINTENDENT'S OFFICE
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04330-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-626-2468
Provider Business Mailing Address Fax Number:
207-626-2444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 GEDNEY ST
Provider Second Line Business Practice Location Address:
SUPERINTENDENT'S OFFICE
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04330-4440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-626-2464
Provider Business Practice Location Address Fax Number:
207-626-2444
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JURDAK
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
S
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
207-626-2487

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: 135930100 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135930100 . This is a "LEA PROVIDER ID" identifier . This identifiers is of the category "OTHER".




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