| Organization Name: | RANDAL JOSEPH THIVIERGE |
| NPI Number: | 1124327564 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JODY L LAVOIE (OPERATIONS MANAGER) |
| Mailing Address: | 625 Rockland St Rockport |
| State: | ME US |
| Postal Code: | 048565320 |
| Phone Number: | 2072363100 |
| Fax Number: | 2072368380 |
| NPI Enumeration Date: | 03/24/2011 |
| NPI Last Update Date: | 11/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 3037 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |