Healthcare Provider Details

I. General information

NPI: 1013353739
Provider Name (Legal Business Name): BATES COLLEGE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 CAMPUS AVE
LEWISTON ME
04240-6009
US

IV. Provider business mailing address

PO BOX 1028
AUBURN ME
04211-1028
US

V. Phone/Fax

Practice location:
  • Phone: 207-786-6199
  • Fax: 207-786-8240
Mailing address:
  • Phone: 207-777-5370
  • Fax: 207-777-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License NumberR021539
License Number StateME

VIII. Authorized Official

Name: CHRISTY TISDALE
Title or Position: MEDICAL DIRECTOR
Credential: FNP
Phone: 207-786-6199