| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 86 Davis Rd, Bangor, Maine |
| Authorized Official Name and Position | Lori L. Dwyer (PRESIDENT & CEO) |
| Authorized Official Contact | 2079929200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1599 103 Maine Ave Bangor ME 04402-1599 Ph: (207) 945-5247 | 86 Davis Rd Bangor ME 04401 Ph: (207) 992-2205 |
| NPI Number | 1740373679 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 08/06/2018 |
| Medicare PECOS PAC ID | 0143212670 |
|---|---|
| Medicare Enrollment ID | O20080418000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740373679 | NPI | - | NPPES |
| 131160200 | Medicaid | ME | |
| MM9086 | Other | MEDICARE GROUP |
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