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NPI Code Detail

MEDICARE: ALPHA ONE MEDICAL

MEDICARE: ALPHA ONE MEDICAL
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
1332BC3200XCustomized Equipment (DME)0225081ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1706197OTHERMEHARVARD PILGRIM PROVIDER
200808OTHERMEANTHEM BLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659477412
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALPHA ONE MEDICAL
Provider Business Mailing Address
First Line : 127 MAIN ST
Second Line :
City : S PORTLAND
State : ME
Zip : 04106-2647
Country : US
Telephone Number : 207-767-5690
Fax Number : 207-767-5997
Provider Business Practice Location Address
First Line : 127 MAIN ST
Second Line :
City : S PORTLAND
State : ME
Zip : 04106-2647
Country : US
Telephone Number : 207-767-5690
Fax Number : 207-767-5997
Authorized Official
Title or Position : GENERAL MANAGER
Name : MR. BRUCE WISHART
Credential :
Telephone Number : 207-767-5690
Provider Enumeration Date : 09/16/2006
Last Update Date : 08/22/2020

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Directions to “ALPHA ONE MEDICAL ” Practice Location

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