1639397664 NPI number — ANN M CHRISTIE PC

Table of content: (NPI 1639397664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639397664 NPI number — ANN M CHRISTIE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANN M CHRISTIE PC
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:
1639397664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 EXCHANGE ST
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-774-6300
Provider Business Mailing Address Fax Number:
207-775-4454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 EXCHANGE ST
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-774-6300
Provider Business Practice Location Address Fax Number:
207-775-4454
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTIE
Authorized Official First Name:
ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
207-774-6300

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY002054 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PY 5524 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PS1197 , 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: 461740 . This is a "VALUE OPTIONS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10751280 . This is a "CAQH" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 200300 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 432779400 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000741584A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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