Healthcare Provider Details

I. General information

NPI: 1306875208
Provider Name (Legal Business Name): MAINE ARTIFICIAL LIMB & ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date: 10/30/2008
Reactivation Date: 05/21/2009

III. Provider practice location address

959 BRIGHTON AVE
PORTLAND ME
04102-1020
US

IV. Provider business mailing address

959 BRIGHTON AVE
PORTLAND ME
04102-1020
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-4963
  • Fax:
Mailing address:
  • Phone: 207-773-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC NICHOLAS KARN
Title or Position: C.E.O.
Credential: C.P.
Phone: 207-773-4963