1841348331 NPI number — BERNARD HADE

Table of content: (NPI 1841348331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841348331 NPI number — BERNARD HADE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERNARD HADE
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:
1841348331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 HATCH DRIVE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
CARIBOU
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-492-1045
Provider Business Mailing Address Fax Number:
207-492-1046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 HATCH DRIVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
CARIBOU
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-492-1045
Provider Business Practice Location Address Fax Number:
207-492-1046
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BURGESS
Authorized Official First Name:
PATTI
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
207-492-1045

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  013280 , 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: 133550000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: RX2438 . This is a "ACTIVE PROVIDER TRANSACTION ACCESS NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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