Basic Information
| Provider Information | |||||||||
| NPI: | 1265065833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAINE MOBILE DIAGNOSTICS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1032 MAIN ST | ||||||||
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| City: | FISHKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125243503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458973330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8 TREMONT ST | ||||||||
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| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041066129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458973330 | ||||||||
| FaxNumber: | 8458973753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2020 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUIDA | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8458973330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.