Healthcare Provider Details

I. General information

NPI: 1356342273
Provider Name (Legal Business Name): NEHE-MRI, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MAIN ST SUITE A
PRESQUE ISLE ME
04769-2804
US

IV. Provider business mailing address

260 MAIN ST SUITE A
PRESQUE ISLE ME
04769-2804
US

V. Phone/Fax

Practice location:
  • Phone: 207-764-6121
  • Fax: 207-764-1942
Mailing address:
  • Phone: 207-764-6121
  • Fax: 207-764-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number1038924
License Number StateME

VIII. Authorized Official

Name: MR. RANDY BACON
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 207-764-6121