NPIMap

Organization Active NPI

Katahdin Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Dover Foxcroft, ME
National Provider Identifier
1053063107
Registry record updated Mar 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KATAHDIN VALLEY HEALTH CENTER
Practice address
48 E Main St
Dover Foxcroft, ME 04426-1323
Phone
(207) 528-2285
Fax
(207) 528-2280
NPI assigned
Jan 20, 2022
Last updated
Mar 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Claudette G Humphrey
Title
Ceo
Phone
(207) 528-2285

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Chiropractor 111N00000X

Addresses

Primary practice location

48 E Main St
Dover Foxcroft, ME 04426-1323

Mailing address

529 S Patten Rd
Patten, ME 04765-3007
Phone (207) 528-2285

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041130000688 ME Part B Supplier - Clinic/Group Practice 4880659903 Receives reassigned benefits from 82 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ashland, ME; Patten, ME; Millinocket, ME; Lincoln, ME; Houlton, ME; Dover Foxcroft, ME; Brownville, ME

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

188 Summer St
Dover Foxcroft, ME 04426
Phone (207) 523-3700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647043200000",
    "number": "1053063107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 S PATTEN RD",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "047653007",
            "telephone_number": "207-528-2285",
            "fax_number": "207-528-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 E MAIN ST",
            "city": "DOVER FOXCROFT",
            "state": "ME",
            "postal_code": "044261323",
            "telephone_number": "207-528-2285",
            "fax_number": "207-528-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATAHDIN VALLEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-03-12",
        "certification_date": "2022-03-12",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "CLAUDETTE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-528-2285"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover Foxcroft, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.