1720044878 NPI number — MAINE EYE CENTER, PA

Table of content: WENDY DUBOIS RN, MSN, MHA (NPI 1699441410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720044878 NPI number — MAINE EYE CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINE EYE CENTER, 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:
1720044878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 LOWELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04102-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-774-8277
Provider Business Mailing Address Fax Number:
207-523-5310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 LOWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102-2776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-774-8277
Provider Business Practice Location Address Fax Number:
207-523-5310
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCANN
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
848-219-2109

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FC0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106700000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490000770 . This is a "RAILROAD FACILITY GROUP #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: M187212 . This is a "CIGNA HS FACILITY GROUP" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: M304 . This is a "CIGNA HEALTHSOURCE GROUP" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 9720 . This is a "NH CIGNA HEALTHSOURCE GRO" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: E00118 . This is a "CHAMPUS GROUP #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2359120 . This is a "AETNA FACILITY GROUP #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 106700200 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99904863 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000335 . This is a "ANTHEM FACILITY GROUP #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 106700100 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106700300 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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