MEDICARE: CASCO BAY ENDOSCOPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	36277	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00057120	OTHER	ME	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538139001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCO BAY ENDOSCOPY

Provider Business Mailing Address
First Line	:	25 LONG CREEK DR
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2440
Country	:	US
Telephone Number	:	207-879-0094
Fax Number	:	207-879-0095

Provider Business Practice Location Address
First Line	:	25 LONG CREEK DR
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2440
Country	:	US
Telephone Number	:	207-879-0094
Fax Number	:	207-879-0095

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	CHRISTINE MARIE DAIGLE
Credential	:	CCP
Telephone Number	:	207-879-0094

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	05/07/2008

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Directions to “CASCO BAY ENDOSCOPY ” Practice Location

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