Organization
STATE OF MAINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN E BALDACCI GOV (GOVERNOR)
(207) 287-3531
Entity
Organization
Contact information
Practice address
91 CAMDEN ST, SUITE 103, ROCKLAND, ME 04841-2455
(207) 596-4200
(207) 596-4370
Mailing address
91 CAMDEN ST, SUITE 103, ROCKLAND, ME 04841-2455
(207) 596-4200
(207) 596-4370
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
8666065
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XVH0920M50019
BLUE CROSS BLUE SHIELD OF MAINE
ME
Enumeration date
02/01/2009
Last updated
02/01/2009
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