Organization
MAINE COAST MOBILE MED. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP J. FORST RADIOGRAPHER (OWNER)
(207) 460-8882
Entity
Organization
Contact information
Practice address
1576 HAMMOND ST STE C, BANGOR, ME 04401-5751
(207) 460-8882
Mailing address
PO BOX 1393, ELLSWORTH, ME 04605-1393
(207) 460-8882
(207) 907-4911
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
RT3575
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132120000
—
ME
Enumeration date
01/22/2010
Last updated
03/17/2018
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