Healthcare Provider Details

I. General information

NPI: 1033316708
Provider Name (Legal Business Name): PHYSICIAN ENGINEERED PRODUCTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SMITH ST
FRYEBURG ME
04037-1182
US

IV. Provider business mailing address

103 SMITH ST
FRYEBURG ME
04037-1182
US

V. Phone/Fax

Practice location:
  • Phone: 207-935-1256
  • Fax: 207-935-1257
Mailing address:
  • Phone: 207-935-1256
  • Fax: 207-935-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberWH70001334
License Number StateME

VIII. Authorized Official

Name: DR. ROB ROSE
Title or Position: CEO
Credential: MD
Phone: 207-935-1256