1285778548 NPI number — DR. GEOFFRY W PHILLIPS MCENANY PHD, APRN, BC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285778548 NPI number — DR. GEOFFRY W PHILLIPS MCENANY PHD, APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS MCENANY
Provider First Name:
GEOFFRY
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, APRN, BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCENANY
Provider Other First Name:
GEOFFRY
Provider Other Middle Name:
W
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD, APRN, BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285778548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 SPRUCE AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEAKS ISLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-696-7925
Provider Business Mailing Address Fax Number:
617-322-1084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 SPRUCE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEAKS ISLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-290-8197
Provider Business Practice Location Address Fax Number:
866-323-2249
Provider Enumeration Date:
02/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0809X , with the licence number:  239814 , 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: 269301000 . This is a "MAGELLAN HEALTH SERVICES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 008805 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 346824 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3737024 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9631-01 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: NS0544 . This is a "MEDICARE PART B" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PN0702 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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