Provider Demographics
NPI:1497054191
Name:AUGUSTA SCHOOL BASED HEALTH CENTER
Entity Type:Organization
Organization Name:AUGUSTA SCHOOL BASED HEALTH CENTER
Other - Org Name:CONY SCHOOL BASED HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESERVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-2468
Mailing Address - Street 1:12 GEDNEY ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4440
Mailing Address - Country:US
Mailing Address - Phone:207-626-2468
Mailing Address - Fax:
Practice Address - Street 1:60 PIERCE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-0619
Practice Address - Country:US
Practice Address - Phone:207-620-8345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2097261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health