1528393238 NPI number — SMARTWORKS INC

Table of content: (NPI 1528393238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528393238 NPI number — SMARTWORKS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMARTWORKS 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:
1528393238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
152 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04239-1507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-897-3102
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
152 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAY
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04239-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-897-3102
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ST JEAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
207-897-3102

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT1492 , 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: 030481 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2233800 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 699511 . This is a "ADVANTRA FREEDOM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: M22455 . This is a "HEALTHSOURCE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: MN2353 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 130310000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6404205 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 7316815 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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