1295855948 NPI number — MAINE EYE CENTER, PA

Table of content: (NPI 1295855948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295855948 NPI number — MAINE EYE CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINE EYE CENTER, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295855948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 LOWELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04102-2726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-774-8277
Provider Business Mailing Address Fax Number:
207-699-5850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 MARGINAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101-2438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-774-8277
Provider Business Practice Location Address Fax Number:
207-699-5850
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCANN
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
848-219-2109

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  36641 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106700300 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: M187212 . This is a "CIGNA HS FACILITY GROUP" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 000335 . This is a "ANTHEM FACILITY GROUP" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2359120 . This is a "AETNA FACILITY GROUP" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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