Provider Demographics
NPI:1265065833
Name:MAINE MOBILE DIAGNOSTICS INC
Entity type:Organization
Organization Name:MAINE MOBILE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-897-3330
Mailing Address - Street 1:1032 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3503
Mailing Address - Country:US
Mailing Address - Phone:845-897-3330
Mailing Address - Fax:
Practice Address - Street 1:8 TREMONT ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6129
Practice Address - Country:US
Practice Address - Phone:845-897-3330
Practice Address - Fax:845-897-3753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty