Basic Information
| Provider Information | |||||||||
| NPI: | 1154340305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILLENNIUM ANESTHESIA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 676 | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042430676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007201664 | ||||||||
| FaxNumber: | 2077532020 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 TER HEUN DR | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084573580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 01/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | KAMP | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5084573580 | ||||||||
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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 | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 668203 | 01 | MA | TUFTS HEALTH | OTHER | M16981 | 01 | MA | BLUE CROSS | OTHER | 9784659 | 05 | MA | MEDICAID |