Maine Molecular Imaging LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

MAINE MOLECULAR IMAGING LLC

Practice address

46 Fairview Ave
Skowhegan, ME 04976-1481

Phone

(800) 734-4132

Fax

(800) 273-2377

NPI assigned

May 5, 2006

Last updated

Oct 5, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brian G Drazba

Title

Senior V.P. & Chief Accounting Ofcr

Phone

(949) 282-6000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Maine Molecular Imaging LLC

  • Physiological Laboratory
  • Scarborough, ME
  • NPI 1316995624

  O20041230000236

  Same enrollment
• Maine Molecular Imaging LLC

  • Physiological Laboratory
  • Waterville, ME
  • NPI 1750339065

  O20041230000236

  Same enrollment
• Maine Molecular Imaging LLC

  • Physiological Laboratory
  • Lewiston, ME
  • NPI 1972551299

  O20041230000236

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael D Digianvittorio, DO

  • Diagnostic Radiology Physician
  • Portland, ME
  • NPI 1568781789
  NPD (past)
• Christopher F Pope, M.D.

  • Diagnostic Radiology Physician
  • Portland, ME
  • NPI 1811069586
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191542400000",
    "number": "1316995632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 414025",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022414025",
            "telephone_number": "949-282-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 FAIRVIEW AVE",
            "city": "SKOWHEGAN",
            "state": "ME",
            "postal_code": "049761481",
            "telephone_number": "800-734-4132",
            "fax_number": "800-273-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINE MOLECULAR IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "DRAZBA",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "SENIOR V.P. & CHIEF ACCOUNTING OFCR",
        "authorized_official_telephone_number": "949-282-6000"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alanna Mary Luther, LCSW
• Marilyn Anne Mackay, LCPC
• Maine Behavioral Health Organization
• Maine Behavioral Health Organization
• Maine Center for Dental Medicine PA
• Martha Carolyn Maloney, LADC
• Timothy C Malyk, M.D.
• Amy Manzer, DPT
• Shirley A Manzer, LSW
• Marathon Health, LLC (MH - New Balance - Central Maine)

• Physiological Laboratory in Skowhegan, ME
• Providers in Skowhegan, ME by specialty
• Physiological Laboratory in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; 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.