1578032058 NPI number — EMERGENCY MEDICINE SERVICES OF MAINE, LLC

Table of content: (NPI 1578032058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578032058 NPI number — EMERGENCY MEDICINE SERVICES OF MAINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY MEDICINE SERVICES OF MAINE, LLC
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:
1578032058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 S EVERGREEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-686-4316
Provider Business Mailing Address Fax Number:
865-291-3254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
447 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04967-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-487-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ISTVAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-686-4306

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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