Provider Demographics
NPI:1841348331
Name:BERNARD HADE
Entity type:Organization
Organization Name:BERNARD HADE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-492-1045
Mailing Address - Street 1:7 HATCH DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736
Mailing Address - Country:US
Mailing Address - Phone:207-492-1045
Mailing Address - Fax:207-492-1046
Practice Address - Street 1:7 HATCH DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736
Practice Address - Country:US
Practice Address - Phone:207-492-1045
Practice Address - Fax:207-492-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0132802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133550000Medicaid
MERX2438OtherACTIVE PROVIDER TRANSACTION ACCESS NUMBER
MERX2438OtherACTIVE PROVIDER TRANSACTION ACCESS NUMBER
ME133550000Medicaid