Provider Demographics
NPI:1942798707
Name:IBIS HEALTH SERVICES-MAINE LLC
Entity type:Organization
Organization Name:IBIS HEALTH SERVICES-MAINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED USER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-921-4947
Mailing Address - Street 1:215 AYER RD UNIT 797
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-5033
Mailing Address - Country:US
Mailing Address - Phone:978-635-9090
Mailing Address - Fax:
Practice Address - Street 1:40 SAINT LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4316
Practice Address - Country:US
Practice Address - Phone:207-558-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty