Provider Demographics
NPI:1477762383
Name:MID COAST CARDIOLOGY
Entity Type:Organization
Organization Name:MID COAST CARDIOLOGY
Other - Org Name:MID COAST CARDIOLOGY ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-721-0341
Mailing Address - Street 1:121 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2653
Mailing Address - Country:US
Mailing Address - Phone:207-721-0341
Mailing Address - Fax:207-725-4717
Practice Address - Street 1:121 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 3100
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2653
Practice Address - Country:US
Practice Address - Phone:207-721-0341
Practice Address - Fax:207-725-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECJ6320Medicaid
MEMM9207Medicare ID - Type UnspecifiedMEDICARE GROUP NO.