1225165129 NPI number — CITY OF BELFAST

Table of content: (NPI 1225165129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225165129 NPI number — CITY OF BELFAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BELFAST
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:
1225165129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDHAM
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04062-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-892-0020
Provider Business Mailing Address Fax Number:
207-893-0583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
273 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELFAST
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-338-3362
Provider Business Practice Location Address Fax Number:
207-236-9679
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
SERVICE CHIEF
Authorized Official Telephone Number:
207-338-3362

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  085 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 0085 , 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: 135960000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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