Provider Demographics
NPI:1194856435
Name:MAINE ORTHOTIC AND PROSTHETIC REHAB SERVICES INC
Entity type:Organization
Organization Name:MAINE ORTHOTIC AND PROSTHETIC REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CO, PT
Authorized Official - Phone:207-773-8818
Mailing Address - Street 1:300 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2914
Mailing Address - Country:US
Mailing Address - Phone:207-773-8818
Mailing Address - Fax:207-773-1204
Practice Address - Street 1:300 PARK AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2914
Practice Address - Country:US
Practice Address - Phone:207-773-8818
Practice Address - Fax:207-773-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME115790000Medicaid
ME0301200001Medicare ID - Type Unspecified