Healthcare Provider Details

I. General information

NPI: 1669779187
Provider Name (Legal Business Name): MAINE MARKETING SOUTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 WARREN AVE UNIT 1
PORTLAND ME
04103-1188
US

IV. Provider business mailing address

352 WARREN AVE UNIT 1
PORTLAND ME
04103-1188
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-8610
  • Fax: 207-871-8618
Mailing address:
  • Phone: 207-871-8610
  • Fax: 207-871-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateME

VIII. Authorized Official

Name: MR. RUSSELL ALAN JOHNSTON
Title or Position: FRANCHISE OWNER
Credential:
Phone: 207-871-8610