Provider Demographics
NPI:1407985302
Name:STATE OF MAINE HEALTH AND ENVIRONMENTAL TESSTING LABORATORY
Entity Type:Organization
Organization Name:STATE OF MAINE HEALTH AND ENVIRONMENTAL TESSTING LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR SCIENTIST CLIA LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:POTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-287-2703
Mailing Address - Street 1:STATION 12
Mailing Address - Street 2:221 STATE STREET
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04333-0001
Mailing Address - Country:US
Mailing Address - Phone:207-287-2703
Mailing Address - Fax:
Practice Address - Street 1:STATION 12
Practice Address - Street 2:221 STATE STREET
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0001
Practice Address - Country:US
Practice Address - Phone:207-287-2703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory