Basic Information
| Provider Information | |||||||||
| NPI: | 1073753927 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAINE HOSPITALIST SERVICE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 WALLACE AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041066143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077610650 | ||||||||
| FaxNumber: | 2077618198 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 BRAMHALL ST | ||||||||
| Address2: | PAVILION 1203 | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076624618 | ||||||||
| FaxNumber: | 2076626254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2009 | ||||||||
| LastUpdateDate: | 03/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | BATES | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | VP MEDICAL AFFAIRS & CMO | ||||||||
| AuthorizedOfficialTelephone: | 2076622776 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.