Healthcare Provider Details

I. General information

NPI: 1588823769
Provider Name (Legal Business Name): HEALTH ACCESS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 BRIDGE STREET
WEST ENFIELD ME
04493
US

IV. Provider business mailing address

PO BOX 99
LINCOLN ME
04457-0099
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-6700
  • Fax: 207-732-5247
Mailing address:
  • Phone: 207-794-6700
  • Fax: 207-732-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CARRIE E GLIDDEN
Title or Position: EMR MANAGER
Credential:
Phone: 207-794-6700