=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538524004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JRO CARDIOLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2015
-----------------------------------------------------
Last Update Date | 12/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 ROUTE 1
-----------------------------------------------------
City | FALMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04105-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-878-5051
-----------------------------------------------------
Fax | 207-797-2166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 ROUTE 1
-----------------------------------------------------
City | FALMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04105-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-878-5051
-----------------------------------------------------
Fax | 207-797-2166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | JOHN R O'MEARA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 207-878-5051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------