Healthcare Provider Details

I. General information

NPI: 1649685447
Provider Name (Legal Business Name): JACE FARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 STEVES LN
MARSHFIELD ME
04654
US

IV. Provider business mailing address

14 STEVES LN
MARSHFIELD ME
04654-5045
US

V. Phone/Fax

Practice location:
  • Phone: 207-255-0996
  • Fax: 207-255-8748
Mailing address:
  • Phone: 207-255-0996
  • Fax: 207-255-8748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: