NPIMap

Organization Active NPI

Katahdin Valley Health Center

  • Dental Clinic/Center
  • Bangor, ME
National Provider Identifier
1356537096
Registry record updated May 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
KATAHDIN VALLEY HEALTH CENTER
Practice address
489 State St
Bangor, ME 04401-6616
Phone
(207) 973-7000
Fax
(207) 528-2880
NPI assigned
Sep 17, 2007
Last updated
May 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2016

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

Authorized official

Name
Durward L Humphrey
Title
Ceo
Phone
(207) 528-2285

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

489 State St
Bangor, ME 04401-6616

Mailing address

PO Box 500
Patten, ME 04765-0500
Phone (207) 528-2285

Other identifiers 1

IdentifierTypeStateIssuer
431497600MedicaidME

National Provider Directory

National Provider Directory
Tax ID family
Katahdin Valley Health Center15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Practitioners & affiliated clinicians

Practitioners 64

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.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463443200000",
    "number": "1356537096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "047650500",
            "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": "489 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016616",
            "telephone_number": "207-973-7000",
            "fax_number": "207-528-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATAHDIN VALLEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-17",
        "last_updated": "2016-05-17",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "DURWARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-528-2285"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "431497600",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.