Penobscot Indian Nation

Primary specialty

Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X

License

PH50000041 Issued in ME

Legal business name

PENOBSCOT INDIAN NATION

Doing business as

PENOBSCOT NATION HEALTH DEPARTMNT

Practice address

23 Wabanaki Way
Indian Island, ME 04468-1252

Phone

(207) 817-7400

Fax

(207) 817-7452

NPI assigned

Aug 14, 2006

Organization subpart

No

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

Authorized official

Name

Patricia Knox Nicola

Title

Director

Phone

(207) 817-7400

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• PENOBSCOT NATION HEALTH DEPARTMNT Doing business as

Tax ID family

Penobscot Indian Nation Finance Office3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Penobscot Indian Nation Finance Office

  • Rural Health Clinic/Center
  • Indian Island, ME
  • NPI 1639139140
  NPD tax ID
• Penobscot Nation Health Department

  • Clinic/Center
  • Indian Island, ME
  • NPI 1801101993
  NPD tax ID

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476144000000",
    "number": "1699788356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 WABANAKI WAY",
            "city": "INDIAN ISLAND",
            "state": "ME",
            "postal_code": "044681252",
            "telephone_number": "207-817-7400",
            "fax_number": "207-817-7452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 WABANAKI WAY",
            "city": "INDIAN ISLAND",
            "state": "ME",
            "postal_code": "044681252",
            "telephone_number": "207-817-7400",
            "fax_number": "207-817-7452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENOBSCOT INDIAN NATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2016-10-11",
        "status": "A",
        "authorized_official_last_name": "KNOX NICOLA",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "207-817-7400"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "ME",
            "license": "PH50000041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106520200",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2036350",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PENOBSCOT NATION HEALTH DEPARTMNT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nancy J. Mitchell Home Trust
• Claud Neptune, LCSW
• Winona Alice Nicolar
• Noli Trpinawzk Corp
• Leslie Maxwell Ohmart III, RPH
• Penobscot Indian Nation Finance Office
• Penobscot Nation Health Department
• Pin RX, LLC
• Edward N. Robertson, DMD,MS
• Merla Roy

• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Indian Island, ME
• Providers in Indian Island, ME by specialty
• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.