Provider Demographics
NPI:1326251000
Name:CITY OF OLD TOWN
Entity Type:Organization
Organization Name:CITY OF OLD TOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-827-7171
Mailing Address - Street 1:156 OAK ST.
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468
Mailing Address - Country:US
Mailing Address - Phone:207-827-7171
Mailing Address - Fax:207-827-3922
Practice Address - Street 1:156 OAK ST.
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468
Practice Address - Country:US
Practice Address - Phone:207-827-7171
Practice Address - Fax:207-827-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136030001Medicaid