Organization
MAINE COAST MOBILE MED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP FORST (OWNER)
(207) 497-2996
Entity
Organization
Contact information
Practice address
1576 HAMMOND ST STE C, BANGOR, ME 04401-5751
(207) 404-4894
(207) 907-4911
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
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040509
BCBS
ME
05
—
132120000
—
ME
01
—
2328397
AETNA
ME
01
—
630001645
RAILROAD MEDICARE
ME
01
—
684929
TUFTS
ME
01
—
M161680
CIGNA
ME
01
—
MN3768
HARVARD PILGRIM
ME
Enumeration date
04/10/2007
Last updated
12/24/2019
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