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General NPI Number Information
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NPI Number | 1538165642
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Entity Type | Organization
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Legal Business Name | BLACK BEAR MEDICAL, INC.
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 275 MARGINAL WAY
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City | PORTLAND
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State | ME
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Zip | 04101-2542
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Country | US
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Telephone | 207-871-0008
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Fax | 207-871-0590
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Provider Business Mailing Address
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Address Line | 1019 TOWN DR
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City | HIGHLAND HEIGHTS
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State | KY
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Zip | 41076-9114
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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 | AUTHORIZED OFFICIAL
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Name | GREGORY CRAWFORD
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Credential |
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Telephone | 859-300-6455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 1019767
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License Number State | ME
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