Provider Demographics
NPI:1801990544
Name:MAINE CENTERS FOR HEALTHCARE
Entity type:Organization
Organization Name:MAINE CENTERS FOR HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PICKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-857-9311
Mailing Address - Street 1:2 CHABOT ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4817
Mailing Address - Country:US
Mailing Address - Phone:207-857-9311
Mailing Address - Fax:207-857-9324
Practice Address - Street 1:2 CHABOT ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4817
Practice Address - Country:US
Practice Address - Phone:207-857-9311
Practice Address - Fax:207-857-9324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1238207RG0100X
ME1385207RG0100X
ME015187208600000X
ME1177208600000X
ME012909208600000X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201014Medicare ID - Type Unspecified