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General NPI Number Information
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NPI Number | 1285758953
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Entity Type | Organization
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Legal Business Name | ASAP MEDICAL CLINICS LLC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 209 WESTERN AVE SUITE B1-B2
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106
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Country | US
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Telephone | 207-553-9071
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Fax | 207-553-9074
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Provider Business Mailing Address
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Address Line | 209 WESTERN AVE SUITE B1-B2
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106
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Country | US
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Telephone | 207-553-9071
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Fax | 207-553-9074
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | TRISH E IBARRA
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Credential |
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Telephone | 207-553-9071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 013647
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 014330
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License Number State | ME
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