Healthcare Provider Details

I. General information

NPI: 1326132218
Provider Name (Legal Business Name): CITY OF BANGOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 TEXAS AVE
BANGOR ME
04401-4324
US

IV. Provider business mailing address

103 TEXAS AVENUE
BANGOR ME
04401
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-4531
  • Fax: 207-945-3348
Mailing address:
  • Phone: 207-992-4547
  • Fax: 207-992-9161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number25100000X
License Number StateME

VIII. Authorized Official

Name: MRS. PATRICIA HAMILTON
Title or Position: DIRECTOR PUBLIC HEALTH NURSING
Credential: FNP
Phone: 207-992-4550