Healthcare Provider Details

I. General information

NPI: 1225124050
Provider Name (Legal Business Name): HOULTON BAND OF MALISEET INDIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CLOVER CIRCLE
HOULTON ME
04730
US

IV. Provider business mailing address

88 BELL RD STE 2
LITTLETON ME
04730-6704
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-4229
  • Fax:
Mailing address:
  • Phone: 207-532-4229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA J PALM
Title or Position: BUSINESS OFFICE MANAGE
Credential: CPC
Phone: 207-532-4229