Organization
CWCL - COASTAL WOMENS CLINICAL LAB
Active
Parent organization
COASTAL WOMENS HEALTHCARE
Other names
Coastal Womens Healthcare Med Lab
Organization subpart
Yes
Provider details
NPI number
Legal business name
COASTAL WOMENS HEALTHCARE
Authorized official
MS. KELLY A GAGNON (OPERATIONS DIRECTOR)
(207) 885-8445
Entity
Organization
Contact information
Practice address
71 US ROUTE ONE, SUITE A, ELEVATION CENTER, SCARBOROUGH, ME 04074-9375
(207) 885-8400
(207) 885-8499
Mailing address
71 US ROUTE ONE, SUITE A, ELEVATION CENTER, SCARBOROUGH, ME 04074-9375
(207) 885-8400
(207) 885-8499
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
20D0088760
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015617
ANTHEM STAR NUMBER
ME
01
—
800794
HARVARD PAYEE NUMBER
ME
Enumeration date
01/19/2007
Last updated
09/23/2010
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