1467439943 NPI number — BRUCE P BATES DO

Table of content: BRUCE P BATES DO (NPI 1467439943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467439943 NPI number — BRUCE P BATES DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATES
Provider First Name:
BRUCE
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1467439943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 284
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRATTLEBORO
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05302-0284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-784-2554
Provider Business Mailing Address Fax Number:
207-777-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACO
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04072-1543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-602-3571
Provider Business Practice Location Address Fax Number:
207-602-3573
Provider Enumeration Date:
12/27/2005

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: 207QG0300X , with the licence number:  896 , 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: 610006701 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 080155424 . This is a "RR MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1044290 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: E06877 . This is a "HPHC" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 30224267 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018064 . This is a "BC/BS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1467439943 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com