Provider Demographics
NPI:1760575609
Name:SHAW HOUSE
Entity Type:Organization
Organization Name:SHAW HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-945-5247
Mailing Address - Street 1:136 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6327
Mailing Address - Country:US
Mailing Address - Phone:207-941-2882
Mailing Address - Fax:
Practice Address - Street 1:1048 UNION ST STE 5
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-8601
Practice Address - Country:US
Practice Address - Phone:207-945-5247
Practice Address - Fax:207-992-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty