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General NPI Number Information
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NPI Number | 1689799504
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Entity Type | Organization
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Legal Business Name | CITY OF PORTLAND
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 39 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04101-2912
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Country | US
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Telephone | 207-874-8446
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Fax |
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Provider Business Mailing Address
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Address Line | 39 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04101-2912
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Country | US
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Telephone | 207-874-8446
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, PUBLIC HEALTH DIVISION
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Name | ALFERDO EDUARDO VERGARA
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Credential | PHD.
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Telephone | 207-874-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | H80CS00005-04-00
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State |
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