1659575371 NPI number — MAINE COAST ANESTHESIA

Table of content: (NPI 1659575371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659575371 NPI number — MAINE COAST ANESTHESIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINE COAST ANESTHESIA
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:
1659575371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9132
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02446-9132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-927-0002
Provider Business Mailing Address Fax Number:
603-893-8886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
329 MAINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04011-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-373-2250
Provider Business Practice Location Address Fax Number:
603-893-8886
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EWERT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
207-373-2250

Provider Taxonomy Codes

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

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

  • Identifier: PENDING , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com