1912077405 NPI number — TOWN OF CUMBERLAND

Table of content: (NPI 1912077405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912077405 NPI number — TOWN OF CUMBERLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF CUMBERLAND
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:
1912077405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDHAM
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04062-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-892-0020
Provider Business Mailing Address Fax Number:
207-893-0583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
366 TUTTLE RD
Provider Second Line Business Practice Location Address:
EMS BILLING
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04021-3627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-829-4085
Provider Business Practice Location Address Fax Number:
207-829-4214
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMALL
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
207-829-5421

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , 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: 136410000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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