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General NPI Number Information
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NPI Number | 1801990544
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Entity Type | Organization
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Legal Business Name | MAINE CENTERS FOR HEALTHCARE
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 07/05/2017
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Provider Practice Location Address
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Address Line | 2 CHABOT ST
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City | WESTBROOK
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State | ME
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Zip | 04092-4817
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Country | US
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Telephone | 207-857-9311
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Fax | 207-857-9324
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Provider Business Mailing Address
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Address Line | 2 CHABOT ST
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City | WESTBROOK
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State | ME
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Zip | 04092-4817
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Country | US
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Telephone | 207-857-9311
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Fax | 207-857-9324
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | OWEN B PICKUS
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Credential | D.O.
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Telephone | 207-857-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 1238
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 1385
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 015187
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 1177
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License Number State | ME
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 012909
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License Number State | ME
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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