Provider Demographics
NPI:1285758953
Name:ASAP MEDICAL CLINICS LLC
Entity type:Organization
Organization Name:ASAP MEDICAL CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRISH
Authorized Official - Middle Name:E
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-553-9071
Mailing Address - Street 1:209 WESTERN AVE
Mailing Address - Street 2:SUITE B1-B2
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-553-9071
Mailing Address - Fax:207-553-9074
Practice Address - Street 1:209 WESTERN AVE
Practice Address - Street 2:SUITE B1-B2
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-553-9071
Practice Address - Fax:207-553-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014330207Q00000X
207Q00000X
ME013647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty