NPIMap

Organization Active NPI

Indian Township Tribal Government

Doing business as Passamaquoddy Health Center

  • Community/Retail Pharmacy
  • Princeton, ME
National Provider Identifier
1619005493
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH50001209 Issued in ME
Legal business name
INDIAN TOWNSHIP TRIBAL GOVERNMENT
Doing business as
Passamaquoddy Health Center
Practice address
401 Peter Dana Point Road
Princeton, ME 04668-0097
Phone
(207) 796-2321
Fax
(207) 796-2422
NPI assigned
Mar 1, 2007
Last updated
Sep 28, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PASSAMAQUODDY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2020

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

Authorized official

Name
Andrea M Hanson
Title
Compliance Specialist
Phone
(207) 796-2321

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X PH50001209 ME Primary

Addresses

Primary practice location

401 Peter Dana Point Road
Princeton, ME 04668-0097

Mailing address

PO Box 97
401 Peter Dana Point Road
Princeton, ME 04668-0097
Phone (207) 796-2321

Other identifiers 2

IdentifierTypeStateIssuer
107940100MedicaidME
200544OtherMENABP

Other names 1

  • PASSAMAQUODDY HEALTH CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Indian TWP Tribal Govt4 organizations share this tax ID, including this one
Part of
Indian TWP Tribal Govt

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1619005493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "address_2": "401 PETER DANA POINT ROAD",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "046680097",
            "telephone_number": "207-796-2321",
            "fax_number": "207-796-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PETER DANA POINT ROAD",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "046680097",
            "telephone_number": "207-796-2321",
            "fax_number": "207-796-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN TOWNSHIP TRIBAL GOVERNMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PASSAMAQUODDY HEALTH CENTER",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "COMPLIANCE SPECIALIST",
        "authorized_official_telephone_number": "207-796-2321"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ME",
            "license": "PH50001209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107940100",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "200544",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PASSAMAQUODDY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; 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.