Provider Demographics
NPI:1598160301
Name:PODIATRY OF NORTHERN MAINE
Entity Type:Organization
Organization Name:PODIATRY OF NORTHERN MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRITITOR
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAUPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-532-9790
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:SHERMAN MILLS
Mailing Address - State:ME
Mailing Address - Zip Code:04776-0130
Mailing Address - Country:US
Mailing Address - Phone:207-532-9790
Mailing Address - Fax:207-532-6550
Practice Address - Street 1:22 NORTH ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1833
Practice Address - Country:US
Practice Address - Phone:207-532-9790
Practice Address - Fax:207-532-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty