1568674232 NPI number — WHITING BAY FAMILY MEDICINE, PA

Table of content: (NPI 1568674232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568674232 NPI number — WHITING BAY FAMILY MEDICINE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITING BAY FAMILY MEDICINE, PA
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:
1568674232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITING
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04691-0108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-733-2900
Provider Business Mailing Address Fax Number:
207-733-2866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 US ROUTE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITING
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-733-2900
Provider Business Practice Location Address Fax Number:
207-733-2866
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GODIN
Authorized Official First Name:
PAT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
207-733-2900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  013026 , 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: 080170735 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 025951 . This is a "ANTHEM BCBS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 610130001 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: F14082 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 098154 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 132790000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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