Provider Demographics
NPI:1134660020
Name:WATERVILLE MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:WATERVILLE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-352-0281
Mailing Address - Street 1:325 WATERVILLE COMMONS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-352-0281
Mailing Address - Fax:844-367-0016
Practice Address - Street 1:325 WATERVILLE COMMONS DRIVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-352-0281
Practice Address - Fax:844-367-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies