Individual ProviderIan AlleyPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address22 Bramhall St, Portland, ME 04102-3134(207) 662-4618(617) 304-5894PECOS EnrollmentBased on the most recent information from CMS, provider Ian Alley 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 ID1487377842Provider TypeIndividualFull NameAlley, IanCredentialPA-CGenderMaleSole ProprietorYesEnumeration Date9/21/2022Last Updated1/18/2023Contact InformationPractice LocationPractice Address22 Bramhall St, Portland, ME 04102-3134Phone(207) 662-4618FaxUnlisted FaxMailing LocationMailing Address1 Boston Way Unit 107, Newburyport, MA 01950-4181Phone(617) 304-5894FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA2457MaineProvider IdentifiersIDDescriptionIssuerIDPA2457DescriptionOtherIssuerLICENSE NUMBERMaineIDPA9034DescriptionOtherIssuerLICESNSE NUMBERMassachusetts