MAESTRO OUTREACH MEDICAL SERVICES, LLC

Provider Demographics

• NPI: 1225332885
• Name: MAESTRO OUTREACH MEDICAL SERVICES, LLC
• Entity Type: Organization
• Organization Name: MAESTRO OUTREACH MEDICAL SERVICES, LLC
• Authorized Official - Title/Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
• Authorized Official - First Name: GEORGE
• Authorized Official - Middle Name: M
• Authorized Official - Last Name: KIONGERA
• Authorized Official - Credentials: NP
• Authorized Official - Phone: 978-973-3749
• Mailing Address - Street 1: 439 S UNION ST
• Mailing Address - Street 2: BUILDING 2, SUITE # 107
• Mailing Address - City: LAWRENCE
• Mailing Address - State: MA
• Mailing Address - Zip Code: 01843-2837
• Mailing Address - Country: US
• Mailing Address - Phone: 978-794-1158
• Mailing Address - Fax: 978-794-1507
• Practice Address - Street 1: 439 S UNION ST
• Practice Address - Street 2: BUILDING 2, SUITE # 107
• Practice Address - City: LAWRENCE
• Practice Address - State: MA
• Practice Address - Zip Code: 01843-2837
• Practice Address - Country: US
• Practice Address - Phone: 978-794-1158
• Practice Address - Fax: 978-794-1507
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: MAESTRO-CONNECTIONS HEALTH SYSTEMS, LLC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2010-12-22
• Last Update Date: 2010-12-27

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207QG0300X	Allopathic & Osteopathic Physicians	Family Medicine	Geriatric Medicine	Group - Single Specialty
No	207QA0401X	Allopathic & Osteopathic Physicians	Family Medicine	Addiction Medicine	Group - Single Specialty
No	207QA0505X	Allopathic & Osteopathic Physicians	Family Medicine	Adult Medicine	Group - Single Specialty
No	208D00000X	Allopathic & Osteopathic Physicians	General Practice		Group - Single Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Single Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Single Specialty
No	363LA2200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Adult Health	Group - Single Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Single Specialty
No	363LG0600X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Gerontology	Group - Single Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Single Specialty
No	363LP2300X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Primary Care	Group - Single Specialty
No	364SA2200X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Adult Health	Group - Single Specialty
No	364SP0808X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health	Group - Single Specialty
No	364SP0809X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health, Adult	Group - Single Specialty
No	364SP0811X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health, Chronically Ill	Group - Single Specialty