Basic Information
| Provider Information | |||||||||
| NPI: | 1568621654 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH ACCESS NETWORK INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044570099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077946700 | ||||||||
| FaxNumber: | 2077946389 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 WEST BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077946700 | ||||||||
| FaxNumber: | 2077946389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | MORRISON | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2077946700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEALTH ACCESS NETWORK | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | POD1016 | ME | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.