Active NPI
Dahl Chase Diagnostic Services
- Clinical Medical Laboratory
- Bangor, ME
National Provider Identifier
1104847110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- License
- 20D0936816
- 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.
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113950000 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 Services
- 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.
-
- Clinical Medical Laboratory
- Bangor, ME
- NPI 1750789897
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.
-
- Specialist
- Bangor, ME
- NPI 1952321507
-
- Anatomic Pathology & Clinical Pathology Physician
- Bangor, ME
- NPI 1235561887
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.