Healthcare Provider Details

I. General information

NPI: 1922465616
Provider Name (Legal Business Name): CENTRAL MAINE CLINICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MESERVE ST
NAPLES ME
04055-5348
US

IV. Provider business mailing address

4 MESERVE ST
NAPLES ME
04055-5348
US

V. Phone/Fax

Practice location:
  • Phone: 207-693-4202
  • Fax: 207-693-5069
Mailing address:
  • Phone: 207-693-4202
  • Fax: 207-693-5069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateME

VIII. Authorized Official

Name: SUSAN MORIN
Title or Position: REGIONAL MANAGER
Credential:
Phone: 207-795-5646