Provider Demographics
NPI:1639230485
Name:CENTRAL MAINE ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:CENTRAL MAINE ENDOSCOPY CENTER, LLC
Other - Org Name:CENTRAL MAINE ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HAWKINS
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:207-680-2070
Mailing Address - Street 1:40 AIRPORT RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4501
Mailing Address - Country:US
Mailing Address - Phone:207-680-2070
Mailing Address - Fax:207-680-2074
Practice Address - Street 1:40 AIRPORT RD STE 2
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4501
Practice Address - Country:US
Practice Address - Phone:207-680-2070
Practice Address - Fax:207-680-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36481261QA1903X, 261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Not Answered261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE 201018Medicare ID - Type Unspecified