Provider Demographics
NPI:1306875208
Name:MAINE ARTIFICIAL LIMB & ORTHOTICS
Entity type:Organization
Organization Name:MAINE ARTIFICIAL LIMB & ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:KARN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:207-773-4963
Mailing Address - Street 1:959 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1020
Mailing Address - Country:US
Mailing Address - Phone:207-773-4963
Mailing Address - Fax:
Practice Address - Street 1:959 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1020
Practice Address - Country:US
Practice Address - Phone:207-773-4963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2009-05-21
Deactivation Date:2008-10-30
Deactivation Code:
Reactivation Date:2009-05-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME106660000Medicaid
0136690001Medicare ID - Type Unspecified