Organization
PORTLAND ENDOSCOPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GOUSSE (PRACTICE ADMINISTRATOR)
(207) 773-7964
Entity
Organization
Contact information
Practice address
161 MARGINAL WAY, PORTLAND, ME 04101-2438
(207) 773-7964
(207) 773-9073
Mailing address
161 MARGINAL WAY, PORTLAND, ME 04101-2438
(207) 773-7964
(207) 773-9073
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118790000
—
ME
Enumeration date
10/04/2006
Last updated
02/14/2025
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