Healthcare Provider Details

I. General information

NPI: 1194176040
Provider Name (Legal Business Name): TRUE NORTH ANESTHESIA L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 HARLOW ST
BANGOR ME
04401-4917
US

IV. Provider business mailing address

PO BOX 986520
BOSTON MA
02298-6520
US

V. Phone/Fax

Practice location:
  • Phone: 614-553-0964
  • Fax:
Mailing address:
  • Phone: 207-784-2554
  • Fax: 207-777-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KATHY MAXWELL
Title or Position: CEO
Credential:
Phone: 207-992-4032