Provider Demographics
NPI:1073753927
Name:MAINE HOSPITALIST SERVICE, INC
Entity Type:Organization
Organization Name:MAINE HOSPITALIST SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MEDICAL AFFAIRS & CMO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-662-2776
Mailing Address - Street 1:39 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6143
Mailing Address - Country:US
Mailing Address - Phone:207-761-0650
Mailing Address - Fax:207-761-8198
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:PAVILION 1203
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-4618
Practice Address - Fax:207-662-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8914Medicare PIN