Provider Demographics
NPI:1043520570
Name:CAPITOL CONVENIENT CARE, LLC
Entity type:Organization
Organization Name:CAPITOL CONVENIENT CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.P. FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BITHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-861-3000
Mailing Address - Street 1:201 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8033
Mailing Address - Country:US
Mailing Address - Phone:207-620-8570
Mailing Address - Fax:207-620-8578
Practice Address - Street 1:174 KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5134
Practice Address - Country:US
Practice Address - Phone:800-395-0232
Practice Address - Fax:207-861-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service