Healthcare Provider Details

I. General information

NPI: 1386808046
Provider Name (Legal Business Name): SPECTRUM MEDICAL MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 SWIFTWATER RD
WOODSVILLE NH
03785-1421
US

IV. Provider business mailing address

PO BOX 336
LEWISTON ME
04243-0336
US

V. Phone/Fax

Practice location:
  • Phone: 603-747-9000
  • Fax:
Mailing address:
  • Phone: 800-472-9586
  • Fax: 207-753-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID B. LANDRY
Title or Position: MANAGER
Credential:
Phone: 207-883-5295