Basic Information
| Provider Information | |||||||||
| NPI: | 1669473591 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AROOSTOOK MRI, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 BAYVIEW CIRCLE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492425592 | ||||||||
| FaxNumber: | 6027733622 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 ACADEMY ST | ||||||||
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| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047693102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006466121 | ||||||||
| FaxNumber: | 8886037003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 09/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | LONGMORE-GRUND | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXEC VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 8005443215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | 1076154 | ME | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
ID Information
| ID | Type | State | Issuer | Description | 172770000 | 05 | ME | MEDICAID |