Provider Demographics
NPI:1013353739
Name:BATES COLLEGE HEALTH CENTER
Entity Type:Organization
Organization Name:BATES COLLEGE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:207-786-6199
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04211-1028
Mailing Address - Country:US
Mailing Address - Phone:207-777-5370
Mailing Address - Fax:207-777-5471
Practice Address - Street 1:31 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6009
Practice Address - Country:US
Practice Address - Phone:207-786-6199
Practice Address - Fax:207-786-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MER021539261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty