Organization Active NPI

Dahl Chase Diagnostic Services

  • Clinical Medical Laboratory
  • Bangor, ME
National Provider Identifier
1104847110
Registry record updated Jun 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
20D0936816 Issued in ME
Legal business name
DAHL CHASE DIAGNOSTIC SERVICES
Practice address
417 State St
Suite 440
Bangor, ME 04401
Phone
(207) 561-2400
Fax
(207) 990-4848
NPI assigned
Jul 22, 2006
Organization subpart
Yes
Parent organization
DAHL-CHASE PATHOLOGY ASSOC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sharon A Swanson
Title
Executive Vice President
Phone
(207) 941-8223

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 20D0936816 ME Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

417 State St
Suite 440
Bangor, ME 04401

Mailing address

417 State St
Suite 440
Bangor, ME 04401-6635
Phone (207) 941-8270

Other identifiers 1

IdentifierTypeStateIssuer
113950000MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000034 ME Part B Supplier - Independent Clinical Laboratory 5698674174 Practice locations: Bangor, ME

National Provider Directory

National Provider Directory
Tax ID family
Dahl Chase Diagnostic Services2 organizations share this tax ID, including this one
Part of
Dahl Chase Pathology

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

417 State St
Ste 440
Bangor, ME 04401
Phone (207) 561-2400

417 State St
Ste 540
Bangor, ME 04401

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591660800000",
    "number": "1104847110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 STATE ST",
            "address_2": "SUITE 440",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016635",
            "telephone_number": "207-941-8270",
            "fax_number": "207-990-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 STATE ST",
            "address_2": "SUITE 440",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-561-2400",
            "fax_number": "207-990-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAHL CHASE DIAGNOSTIC SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAHL-CHASE PATHOLOGY ASSOC.",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A",
        "authorized_official_last_name": "SWANSON",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "207-941-8223",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ME",
            "license": "20D0936816",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113950000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.