Provider Demographics
NPI:1437485117
Name:CITY OF PORTLAND MAINE
Entity Type:Organization
Organization Name:CITY OF PORTLAND MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:P
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-874-8944
Mailing Address - Street 1:389 CONGRESS ST
Mailing Address - Street 2:ROOM 307
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3566
Mailing Address - Country:US
Mailing Address - Phone:207-874-8784
Mailing Address - Fax:207-874-8913
Practice Address - Street 1:103 INDIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4211
Practice Address - Country:US
Practice Address - Phone:207-874-8446
Practice Address - Fax:207-756-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM5065Medicare PIN