Healthcare Provider Details

I. General information

NPI: 1184678088
Provider Name (Legal Business Name): ST. JOSEPH AMBULATORY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BROADWAY
BANGOR ME
04401-1900
US

IV. Provider business mailing address

PO BOX 934
BANGOR ME
04402-0934
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-3380
  • Fax: 207-907-3389
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HENDRIX
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 207-907-1600