1750563888 NPI number — WEBBER HOSPITAL ASSOCIATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750563888 NPI number — WEBBER HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEBBER HOSPITAL ASSOCIATION
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:
SMMC INTERNAL MEDICINE
Provider Other Organization Name Type Code:
3
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:
1750563888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 WALLACE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04106-6143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-283-7000
Provider Business Mailing Address Fax Number:
207-283-7070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 MAIN ST
Provider Second Line Business Practice Location Address:
PARK SQUARE
Provider Business Practice Location Address City Name:
KENNEBUNK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04043-7021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-467-8909
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAVOIE
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
VP MEDICAL AFFAIRS
Authorized Official Telephone Number:
207-283-7898

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 432732804 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101580000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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