Provider Demographics
NPI:1467704411
Name:STICKMAN DIALYSIS INDUSTRIES
Entity Type:Organization
Organization Name:STICKMAN DIALYSIS INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-985-1717
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-0415
Mailing Address - Country:US
Mailing Address - Phone:207-985-1717
Mailing Address - Fax:207-985-1718
Practice Address - Street 1:2210 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-7930
Practice Address - Country:US
Practice Address - Phone:207-985-1717
Practice Address - Fax:207-985-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies