Provider Demographics
NPI:1003434655
Name:CENTER FOR INTEGRATIVE AND REGENERATIVE MEDICINE
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATIVE AND REGENERATIVE MEDICINE
Other - Org Name:CENTER FOR INTEGRATIVE AND REGENERATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARDIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-947-9200
Mailing Address - Street 1:277 STATE ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:277 STATE ST STE 1B
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5440
Practice Address - Country:US
Practice Address - Phone:207-947-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center