Provider Demographics
NPI:1720166697
Name:NEW ENGLAND MOBILE X-RAY
Entity Type:Organization
Organization Name:NEW ENGLAND MOBILE X-RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-341-9729
Mailing Address - Street 1:891 BRIGHTON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1056
Mailing Address - Country:US
Mailing Address - Phone:617-341-9729
Mailing Address - Fax:
Practice Address - Street 1:891 BRIGHTON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1056
Practice Address - Country:US
Practice Address - Phone:617-341-9729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME209800Medicare ID - Type Unspecified