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General NPI Number Information
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NPI Number | 1184955692
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Entity Type | Organization
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Legal Business Name | MAINE COAST MOBILE MED. LLC
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1576 HAMMOND ST STE C
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City | BANGOR
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State | ME
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Zip | 04401-5751
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Country | US
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Telephone | 207-460-8882
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1393
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City | ELLSWORTH
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State | ME
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Zip | 04605-1393
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Country | US
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Telephone | 207-460-8882
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Fax | 207-907-4911
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Authorized Official
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Title or Position | OWNER
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Name | MR. PHILIP J. FORST
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Credential | RADIOGRAPHER
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Telephone | 207-460-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | RT3575
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License Number State | ME
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