Provider Demographics
NPI:1316171796
Name:AMEDISYS MAINE, PLLC
Entity type:Organization
Organization Name:AMEDISYS MAINE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:
Practice Address - Street 1:23 WATER ST
Practice Address - Street 2:SUITE A
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6364
Practice Address - Country:US
Practice Address - Phone:207-990-0029
Practice Address - Fax:207-990-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME03114251E00000X
ME03162251E00000X
ME38079251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1316171796Medicaid
ME436317200Medicaid
ME207075Medicare Oscar/Certification