Provider Demographics
NPI:1588823769
Name:HEALTH ACCESS NETWORK INC
Entity Type:Organization
Organization Name:HEALTH ACCESS NETWORK INC
Other - Org Name:HEALTH ACCESS NETWORK-WEST ENFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GLIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-794-6700
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0099
Mailing Address - Country:US
Mailing Address - Phone:207-794-6700
Mailing Address - Fax:207-732-5247
Practice Address - Street 1:47 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:WEST ENFIELD
Practice Address - State:ME
Practice Address - Zip Code:04493
Practice Address - Country:US
Practice Address - Phone:207-794-6700
Practice Address - Fax:207-732-5247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH ACCESS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-03
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM9709Medicare PIN
ME201836Medicare Oscar/Certification