Provider Demographics
NPI:1114954765
Name:ORTHOPAEDIC ASSOCIATES OF PORTLAND, PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF PORTLAND, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WIPFLER
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MBA
Authorized Official - Phone:207-828-2100
Mailing Address - Street 1:PO BOX 1260
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-1260
Mailing Address - Country:US
Mailing Address - Phone:207-828-2100
Mailing Address - Fax:207-828-2190
Practice Address - Street 1:33 SEWALL STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-828-2100
Practice Address - Fax:207-828-2190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC ASSOCIATES OF PORTLAND, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-27
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0731460001Medicare ID - Type UnspecifiedORTHOPAEDIC ASSOCIATES