Provider Demographics
NPI:1649383704
Name:KNOWLTON, SPENCER (CEO)
Entity Type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:
Last Name:KNOWLTON
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:MR
Other - First Name:SPENCER
Other - Middle Name:
Other - Last Name:KNOWLTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO
Mailing Address - Street 1:PO BOX 951
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-0951
Mailing Address - Country:US
Mailing Address - Phone:207-236-3006
Mailing Address - Fax:207-236-1018
Practice Address - Street 1:14 MILL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1510
Practice Address - Country:US
Practice Address - Phone:207-236-3006
Practice Address - Fax:207-236-1018
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MENOT REQUIRED332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0123540001Medicare ID - Type UnspecifiedPROVIDER ID NUMBER