Maine Coast Mobile Med, LLC

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) 404-4894

Fax

(207) 907-4911

NPI assigned

Apr 10, 2007

Organization subpart

No

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

Authorized official

Name

Phillip Forst

Title

Owner

Phone

(207) 497-2996

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

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.

• Maine Coast Mobile Med. LLC

  • Radiologic Technologist
  • Bangor, ME
  • NPI 1184955692
  NPD tax ID

Locations

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577145600000",
    "number": "1710100839",
    "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": "207-404-4894",
            "fax_number": "207-907-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINE COAST MOBILE MED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2019-12-24",
        "certification_date": "2019-12-24",
        "status": "A",
        "authorized_official_last_name": "FORST",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-497-2996"
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiologic Technologist",
            "state": "ME",
            "license": "RT3575",
            "primary": true
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "684929",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132120000",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "MN3768",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2328397",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "M161680",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "630001645",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "040509",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charissa Marie Maguire, LCSW
• Stephanie Maguire, PT, DPT
• Katie Mahon
• Kathryn Maietta, LCSW
• Brenda Mailman, RN
• Maine Coast Mobile Med. LLC
• Maine Family Dental Practice PA
• Maine Functional Medicine
• Maine Molecular Imaging LLC
• Maine Street Medicine Works, PLLC

• Radiologic Technologist in Bangor, ME
• Providers in Bangor, ME by specialty
• Radiologic Technologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2019; 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.