Healthcare Provider Details

I. General information

NPI: 1306951231
Provider Name (Legal Business Name): NORTHERN MAINE AMBULATORY ENDOSCOPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MARTIN ST
PRESQUE ISLE ME
04769-2238
US

IV. Provider business mailing address

11 MARTIN ST
PRESQUE ISLE ME
04769-2238
US

V. Phone/Fax

Practice location:
  • Phone: 207-764-0679
  • Fax: 207-764-1569
Mailing address:
  • Phone: 207-764-0679
  • Fax: 207-764-1569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number36488
License Number StateME

VIII. Authorized Official

Name: WILLIAM SILBER
Title or Position: PRESIDENT
Credential:
Phone: 207-764-0679