Healthcare Provider Details

I. General information

NPI: 1962450650
Provider Name (Legal Business Name): CENTRAL MAINE MAGNETIC IMAGING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 MAIN ST STE 100
LEWISTON ME
04240-7054
US

IV. Provider business mailing address

287 MAIN ST STE 100
LEWISTON ME
04240-7054
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-2030
  • Fax: 207-795-2030
Mailing address:
  • Phone: 207-795-2030
  • Fax: 207-795-2030

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: JAMES F. STANLEY
Title or Position: CFO
Credential:
Phone: 952-543-6504