Provider Demographics
NPI:1073518320
Name:NEW ENGLAND BRACE CO., INC.
Entity Type:Organization
Organization Name:NEW ENGLAND BRACE CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GUIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:603-668-8360
Mailing Address - Street 1:217 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7069
Mailing Address - Country:US
Mailing Address - Phone:207-786-0101
Mailing Address - Fax:207-786-0216
Practice Address - Street 1:217 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7069
Practice Address - Country:US
Practice Address - Phone:207-786-0101
Practice Address - Fax:207-786-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME138580001Medicaid
ME700383OtherHARVARD PILGRIM
ME4696OtherCIGNA
VT1002782Medicaid
ME19Z025773ME0OtherBCBS
NH80547363Medicaid
NH80547363Medicaid