1205266756 NPI number — THE SHAW AGENCY, INC.

Table of content: JONATHAN RIGGIN LOWE NP (NPI 1932658697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205266756 NPI number — THE SHAW AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SHAW AGENCY, 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:
1205266756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 DAMASCUS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04937-4307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-453-7987
Provider Business Mailing Address Fax Number:
207-453-7987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 DAMASCUS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04937-4307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-453-7987
Provider Business Practice Location Address Fax Number:
207-453-7987
Provider Enumeration Date:
11/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHAW
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
ESTHER
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
207-453-7987

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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