1558699314 NPI number — DR. RICKIE LANE AMES D,C,

Table of content: DR. RICKIE LANE AMES D,C, (NPI 1558699314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558699314 NPI number — DR. RICKIE LANE AMES D,C,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMES
Provider First Name:
RICKIE
Provider Middle Name:
LANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D,C,
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:
1558699314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 ABBOTT HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEXTER
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04930-1154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-907-2637
Provider Business Mailing Address Fax Number:
207-990-2308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 ABBOTT HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEXTER
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04930-1154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-907-2637
Provider Business Practice Location Address Fax Number:
207-990-2308
Provider Enumeration Date:
12/05/2009

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: 111N00000X , with the licence number:  CR1914 , 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: 1730510090 . This is a "CLINIC NPI" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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