Provider Demographics
NPI:1962450650
Name:CENTRAL MAINE MAGNETIC IMAGING ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL MAINE MAGNETIC IMAGING ASSOCIATES
Other - Org Name:CENTRAL MAINE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-543-6504
Mailing Address - Street 1:287 MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7054
Mailing Address - Country:US
Mailing Address - Phone:207-795-2030
Mailing Address - Fax:207-795-2030
Practice Address - Street 1:287 MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7054
Practice Address - Country:US
Practice Address - Phone:207-795-2030
Practice Address - Fax:207-795-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME189080000Medicaid
ME189080000Medicaid