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General NPI Number Information
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NPI Number | 1487256186
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Entity Type | Organization
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Legal Business Name | BISHOP MEDICAL GROUP LLC
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1250 FOREST AVE STE 201
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City | PORTLAND
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State | ME
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Zip | 04103-6403
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Country | US
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Telephone | 207-671-3047
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 FOREST AVE STE 201
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City | PORTLAND
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State | ME
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Zip | 04103-6403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN BURO
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Credential |
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Telephone | 207-910-6580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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