Healthcare Provider Details

I. General information

NPI: 1922449834
Provider Name (Legal Business Name): PINES HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 MAIN STREET
WASHBURN ME
04786
US

IV. Provider business mailing address

74 ACCESS HWY
CARIBOU ME
04736-3807
US

V. Phone/Fax

Practice location:
  • Phone: 207-455-4750
  • Fax: 207-455-4729
Mailing address:
  • Phone: 207-498-2359
  • Fax: 207-498-2352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES M DAVIS
Title or Position: CEO
Credential:
Phone: 207-498-2359