NPIMap

Organization Active NPI

Maine Coast Mobile Med. LLC

  • Radiologic Technologist
  • Bangor, ME
National Provider Identifier
1184955692
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiologic TechnologistTaxonomy code 247100000X
License
RT3575 Issued in ME
Legal business name
MAINE COAST MOBILE MED. LLC
Practice address
1576 Hammond St Ste C
Bangor, ME 04401-5751
Phone
(207) 460-8882
NPI assigned
Jan 22, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Mr. Philip J. Forst, RADIOGRAPHER
Title
Owner
Phone
(207) 460-8882

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiologic TechnologistGroup: 193400000X SINGLE SPECIALTY GROUP 247100000X RT3575 ME Primary

Addresses

Primary practice location

1576 Hammond St Ste C
Bangor, ME 04401-5751

Mailing address

PO Box 1393
Ellsworth, ME 04605-1393
Phone (207) 460-8882

Other practice location 1

1576C Hammon Street
Bangor, MA 04401-0000
Phone (207) 460-8882

Other identifiers 1

IdentifierTypeStateIssuer
132120000MedicaidME

National Provider Directory

National Provider Directory
Tax ID family
Maine Coast Mobile Med LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1184955692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1393",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046051393",
            "telephone_number": "207-460-8882",
            "fax_number": "207-907-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1576 HAMMOND ST STE C",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015751",
            "telephone_number": "207-460-8882"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1576C Hammon Street",
            "address_purpose": "LOCATION",
            "city": "Bangor",
            "state": "MA",
            "postal_code": "044010000",
            "country_code": "US",
            "telephone_number": "207-460-8882",
            "fax_number": "207-907-4911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAINE COAST MOBILE MED. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-22",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "FORST",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-460-8882",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RADIOGRAPHER"
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiologic Technologist",
            "state": "ME",
            "license": "RT3575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132120000",
            "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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.