Provider Demographics
NPI:1235227919
Name:MEDICAL CARE DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:MEDICAL CARE DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:FHFMA, MBA
Authorized Official - Phone:207-622-7566
Mailing Address - Street 1:11 PARKWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330
Mailing Address - Country:US
Mailing Address - Phone:207-622-7566
Mailing Address - Fax:207-623-8851
Practice Address - Street 1:11 PARKWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-622-7566
Practice Address - Fax:207-623-8851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL CARE DEVELOPMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251B00000X251B00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200899Medicare PIN
ME200899Medicare Oscar/Certification
CCDP00007Medicare Oscar/Certification
CCDP00007Medicare PIN