Healthcare Provider Details

I. General information

NPI: 1639109366
Provider Name (Legal Business Name): INTEGRATED MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AIRPORT RD SUITE 2
WATERVILLE ME
04901-4524
US

IV. Provider business mailing address

40 AIRPORT RD SUITE 2
WATERVILLE ME
04901-4524
US

V. Phone/Fax

Practice location:
  • Phone: 207-680-2070
  • Fax: 207-680-2074
Mailing address:
  • Phone: 207-680-2070
  • Fax: 207-680-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN HAWKINS IRWIN III
Title or Position: OWNER
Credential: D.O.
Phone: 207-680-2070