Provider Demographics
NPI:1356342273
Name:NEHE-MRI, L.L.C.
Entity type:Organization
Organization Name:NEHE-MRI, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-6121
Mailing Address - Street 1:260 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2804
Mailing Address - Country:US
Mailing Address - Phone:207-764-6121
Mailing Address - Fax:207-764-1942
Practice Address - Street 1:260 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2804
Practice Address - Country:US
Practice Address - Phone:207-764-6121
Practice Address - Fax:207-764-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1038924261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2140797OtherAETNA PROVIDER NUMBER
ME327026Medicare ID - Type Unspecified