Healthcare Provider Details

I. General information

NPI: 1639230485
Provider Name (Legal Business Name): CENTRAL MAINE ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AIRPORT RD STE 2
WATERVILLE ME
04901-4501
US

IV. Provider business mailing address

40 AIRPORT RD STE 2
WATERVILLE ME
04901-4501
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 TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number36481
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number36481
License Number StateME

VIII. Authorized Official

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