Healthcare Provider Details

I. General information

NPI: 1801848791
Provider Name (Legal Business Name): MAINE COAST PHYSICIAN AFFILIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 UNION ST
ELLSWORTH ME
04605-1586
US

IV. Provider business mailing address

50 UNION ST
ELLSWORTH ME
04605-1586
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-5497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1061763
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1061763
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1061763
License Number StateME

VIII. Authorized Official

Name: KEVIN SEDGWICK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 207-664-5497