| Center For Integrative And Regenerative Medicine | |
|
277 State St Ste 1b Bangor ME 04401-5440 | |
| (207) 947-9200 | |
| Not Available |
| Full Name | Center For Integrative And Regenerative Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 277 State St Ste 1b, Bangor, Maine |
| Authorized Official Name and Position | Jacqueline Tardif (OFFICE MANAGER) |
| Authorized Official Contact | 2079479200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Integrative And Regenerative Medicine 277 State St Ste 1b Bangor ME 04401-5440 Ph: () - | Center For Integrative And Regenerative Medicine 277 State St Ste 1b Bangor ME 04401-5440 Ph: (207) 947-9200 |
| NPI Number | 1003434655 |
|---|---|
| Provider Enumeration Date | 07/10/2020 |
| Last Update Date | 08/31/2020 |
| Medicare PECOS PAC ID | 9436575651 |
|---|---|
| Medicare Enrollment ID | O20200722002437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003434655 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Susan K Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487682290 PECOS PAC ID: 3870507874 Enrollment ID: I20060130000303 |
| Provider Name | Sara Dayon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932578531 PECOS PAC ID: 0648570754 Enrollment ID: I20151121000042 |
| Provider Name | Auteum M Lake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629594882 PECOS PAC ID: 4284900531 Enrollment ID: I20171101000567 |
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