Healthcare Provider Details

I. General information

NPI: 1366553091
Provider Name (Legal Business Name): SOUTHERN MAINE GERIATRICS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MARQUIS RD
FREEPORT ME
04032-6477
US

IV. Provider business mailing address

50 MARQUIS RD
FREEPORT ME
04032-6477
US

V. Phone/Fax

Practice location:
  • Phone: 207-865-6131
  • Fax: 207-865-9399
Mailing address:
  • Phone: 207-865-6131
  • Fax: 207-865-9399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J BITHER
Title or Position: OWNER
Credential: MD
Phone: 207-865-6131