Healthcare Provider Details

I. General information

NPI: 1780948943
Provider Name (Legal Business Name): CENTRAL MAINE MAGNETIC IMAGING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 MINOT AVE SUITE 3
AUBURN ME
04210-3922
US

IV. Provider business mailing address

140 CANAL ST
LEWISTON ME
04240-7777
US

V. Phone/Fax

Practice location:
  • Phone: 207-782-3644
  • Fax: 207-782-3646
Mailing address:
  • Phone: 207-782-3644
  • Fax: 207-782-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA R. BLANK
Title or Position: EXECUTIVE VICE PRESIDENT - BUSINESS
Credential:
Phone: 949-282-6000