Provider Demographics
NPI:1326132218
Name:CITY OF BANGOR
Entity Type:Organization
Organization Name:CITY OF BANGOR
Other - Org Name:BANGOR HEALTH & COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PUBLIC HEALTH NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:207-992-4550
Mailing Address - Street 1:103 TEXAS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-992-4547
Mailing Address - Fax:207-992-9161
Practice Address - Street 1:103 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4324
Practice Address - Country:US
Practice Address - Phone:207-992-4531
Practice Address - Fax:207-945-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME25100000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135940700Medicaid
ME135410400Medicaid
ME135410400Medicaid