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NPI Code Detail

MEDICARE: PASSAMAQUODDY TRIBAL COUNCIL

MEDICARE: PASSAMAQUODDY TRIBAL COUNCIL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760474613
Entity Type Code : Organization
Provider Name (Legal Business Name) : PASSAMAQUODDY TRIBAL COUNCIL
Provider Business Mailing Address
First Line : PO BOX 351
Second Line :
City : PERRY
State : ME
Zip : 04667-0351
Country : US
Telephone Number : 207-853-0644
Fax Number : 207-853-2347
Provider Business Practice Location Address
First Line : 11 BACK RD
Second Line :
City : PLEASANT POINT
State : ME
Zip : 04667-4119
Country : US
Telephone Number : 207-853-0644
Fax Number : 207-853-2347
Authorized Official
Title or Position : ADMIN ASSISTANT
Name : CRYSTAL BORE
Credential :
Telephone Number : 207-853-0555
Provider Enumeration Date : 08/17/2005
Last Update Date : 04/18/2024

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Practice Location Address:
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1740251172 — DR. MARY JO MILES CALEBAUGH MD
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1366526188 — PASSAMAQUODDY TRIBAL COUNCIL
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04667-4119
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1699817452 — DR. CECILIA DIAS DDS
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1619113636 — KATHLEEN ALFREDA MAJKA R.D., L.D
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Directions to “PASSAMAQUODDY TRIBAL COUNCIL ” Practice Location

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