1922665348 NPI number — MARCIA L VANBUSKIRK

Table of content: MARCIA L VANBUSKIRK (NPI 1922665348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922665348 NPI number — MARCIA L VANBUSKIRK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANBUSKIRK
Provider First Name:
MARCIA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VANBUSKIRK
Provider Other First Name:
MARCIA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922665348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
353 CUSHING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUSHING
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04563-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-354-5429
Provider Business Mailing Address Fax Number:
207-354-5429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 CUSHING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUSHING
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04563-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-354-5429
Provider Business Practice Location Address Fax Number:
207-354-5429
Provider Enumeration Date:
05/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376J00000X , with the licence number:  1114576980 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1114576980 . This is a "VETERANS ADMINISTRATION" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1114576980 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com