NPIViewer - Provider NPI 1396737656

NPI:	1396737656
Name:	CASCO BAY SURGERY, PA
Entity type:	Organization
Organization Name:	CASCO BAY SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	PRESIDENT
Authorized Official - Prefix:	MR
Authorized Official - First Name:	CATHEL
Authorized Official - Middle Name:	AH
Authorized Official - Last Name:	MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:	MD
Authorized Official - Phone:	207-761-6642
Mailing Address - Street 1:	10 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:	PORTLAND
Mailing Address - State:	ME
Mailing Address - Zip Code:	04102-1954
Mailing Address - Country:	US
Mailing Address - Phone:	207-761-6642
Mailing Address - Fax:	207-773-2603
Practice Address - Street 1:	10 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:	PORTLAND
Practice Address - State:	ME
Practice Address - Zip Code:	04102-1954
Practice Address - Country:	US
Practice Address - Phone:	207-761-6642
Practice Address - Fax:	207-773-2603
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2005-08-22
Last Update Date:	2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization	Group
Yes	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	208C00000X	Allopathic & Osteopathic Physicians	Colon & Rectal Surgery		Group - Multi-Specialty

State	Identifier ID	ID Type
ME	287310099	Medicaid
ME	154600000	Medicaid
ME	154600099	Medicaid
ME	302490099	Medicaid
ME	251740099	Medicaid
ME	303190099	Medicaid
ME	338700099	Medicaid
ME	302490099	Medicaid
ME	ME0192	Medicare PIN
ME	MM4578	Medicare PIN
ME	MM7944	Medicare PIN
ME	E98205	Medicare UPIN
ME	E69120	Medicare UPIN
ME	338700099	Medicaid
ME	154600000	Medicaid
ME	154600099	Medicaid
ME	MM2629	Medicare PIN
ME	G46473	Medicare UPIN
ME	MM8962	Medicare PIN
ME	251740099	Medicaid