Provider Demographics
NPI:1548550635
Name:GREAT SCOTT AUDIOLOGY, PA
Entity type:Organization
Organization Name:GREAT SCOTT AUDIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:207-729-4086
Mailing Address - Street 1:331 MAINE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3358
Mailing Address - Country:US
Mailing Address - Phone:207-729-4086
Mailing Address - Fax:207-449-1193
Practice Address - Street 1:331 MAINE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3358
Practice Address - Country:US
Practice Address - Phone:207-729-4086
Practice Address - Fax:207-449-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP1273231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME273250099Medicaid
ME273250099Medicaid