Provider Demographics
NPI:1598948283
Name:OTOLARYNGOLOGY ASSOCIATES LLC, PA
Entity Type:Organization
Organization Name:OTOLARYNGOLOGY ASSOCIATES LLC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAHEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-784-4539
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-1288
Mailing Address - Country:US
Mailing Address - Phone:207-784-4539
Mailing Address - Fax:207-784-2868
Practice Address - Street 1:12 BATES ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7675
Practice Address - Country:US
Practice Address - Phone:207-784-4539
Practice Address - Fax:207-784-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME153340Medicare UPIN