Provider Demographics
NPI:1477765048
Name:MAINE SCHOOL ADMINISTRATION DISTRICT NO 74
Entity Type:Organization
Organization Name:MAINE SCHOOL ADMINISTRATION DISTRICT NO 74
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:207-635-2727
Mailing Address - Street 1:P.O. BOX 219
Mailing Address - Street 2:56 NORTH MAIN STREET
Mailing Address - City:NORTH ANSON
Mailing Address - State:ME
Mailing Address - Zip Code:04958
Mailing Address - Country:US
Mailing Address - Phone:207-635-2727
Mailing Address - Fax:207-635-3599
Practice Address - Street 1:56 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTH ANSON
Practice Address - State:ME
Practice Address - Zip Code:04958
Practice Address - Country:US
Practice Address - Phone:207-635-2727
Practice Address - Fax:207-635-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104510000Medicaid