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General NPI Number Information
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NPI Number | 1184648594
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERAN AFFAIRS
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 163 VAN BUREN RD SUITE 6
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City | CARIBOU
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State | ME
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Zip | 04736-3567
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Country | US
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Telephone | 207-485-1711
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Fax | 207-493-3877
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Provider Business Mailing Address
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Address Line | 163 VAN BUREN RD SUITE 6
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City | CARIBOU
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State | ME
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Zip | 04736-3567
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Country | US
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Telephone | 207-485-1711
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Fax | 207-493-3877
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Authorized Official
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Title or Position | GEC CARE LINE MANAGER
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Name | JOHN P. MCEWAN
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Credential | CSW
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Telephone | 207-623-8411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | 6801086877
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License Number State | MI
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