Provider Demographics
NPI:1447520812
Name:MERET C BAINBRIDGE
Entity type:Organization
Organization Name:MERET C BAINBRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.AC.
Authorized Official - Prefix:MS
Authorized Official - First Name:MERET
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAINBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MAAOM
Authorized Official - Phone:207-838-2413
Mailing Address - Street 1:35 STORER ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2718
Mailing Address - Country:US
Mailing Address - Phone:207-838-2413
Mailing Address - Fax:207-994-2164
Practice Address - Street 1:35 STORER ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072
Practice Address - Country:US
Practice Address - Phone:207-838-2413
Practice Address - Fax:207-994-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC 160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA50ME02683ME01OtherANTHEM OF MAINE
ME1447520812MEOtherANTHEM OF MAINE MEDICARE DEPARTMENT