1194861633 NPI number — AMY MOONEY, D.C.

Table of content: (NPI 1194861633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194861633 NPI number — AMY MOONEY, D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMY MOONEY, D.C.
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:
AMY MOONEY, D.C.
Provider Other Organization Name Type Code:
3
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:
1194861633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 DARTMOUTH ST
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101-1700
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:
117 GREAT RD
Provider Second Line Business Practice Location Address:
GLOBAL FITNESS CENTER
Provider Business Practice Location Address City Name:
STOW
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01775-1191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-897-0393
Provider Business Practice Location Address Fax Number:
978-897-3110
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWELLEN
Authorized Official First Name:
AMY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-897-0393

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" .

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

  • Identifier: Y40038 . This is a "BCBS GROUP" 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".
  • Identifier: Y36775 . This is a "BCBS OF MA INDIVIDUAL" 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: 80877 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6307932001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 44-02698 . This is a "UHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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