Individual ProviderMeredith BeauregardPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address22 Bramhall St, Pavilion 1203, Portland, ME 04102(207) 662-4618(207) 396-8600PECOS EnrollmentBased on the most recent information from CMS, provider Meredith Beauregard is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 2:35 PM.Profile DetailsProvider ID1013967918Provider TypeIndividualFull NameBeauregard, MeredithCredentialPAGenderFemaleSole ProprietorNoEnumeration Date5/11/2006Last Updated1/3/2011Contact InformationPractice LocationPractice Address22 Bramhall St, Pavilion 1203, Portland, ME 04102Phone(207) 662-4618Fax(207) 662-6254Mailing LocationMailing Address301 Us Route 1, Building C, Scarborough, ME 04074-7609Phone(207) 396-8600Fax(207) 396-8632Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA883MaineProvider IdentifiersIDDescriptionIssuerID432498699DescriptionMedicaidIssuerUnlistedMaine