Provider Demographics
NPI:1124153499
Name:SURGICARE INC
Entity type:Organization
Organization Name:SURGICARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DILIDDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-290-1807
Mailing Address - Street 1:71 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1105
Mailing Address - Country:US
Mailing Address - Phone:800-797-8744
Mailing Address - Fax:800-338-6304
Practice Address - Street 1:190 RIVERSIDE ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1073
Practice Address - Country:US
Practice Address - Phone:207-773-7896
Practice Address - Fax:207-773-4645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGI-CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-23
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME332B00000X332B00000X
ME335E00000X335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME151040001Medicaid
ME001539OtherBCBS OF ME
ME2250383OtherCIGNA
ME151040001Medicaid