Provider Demographics
NPI:1306951231
Name:NORTHERN MAINE AMBULATORY ENDOSCOPY CENTER
Entity type:Organization
Organization Name:NORTHERN MAINE AMBULATORY ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SILBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-0679
Mailing Address - Street 1:11 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2238
Mailing Address - Country:US
Mailing Address - Phone:207-764-0679
Mailing Address - Fax:207-764-1569
Practice Address - Street 1:11 MARTIN ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2238
Practice Address - Country:US
Practice Address - Phone:207-764-0679
Practice Address - Fax:207-764-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36488261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME490003212OtherRAILROAD MEDICARE
ME9107978OtherCIGNA
ME026465OtherANTHEM
ME5989270OtherAETNA
ME130120000MEMedicaid
ME201010Medicare ID - Type Unspecified