Healthcare Provider Details

I. General information

NPI: 1144687054
Provider Name (Legal Business Name): CENTRAL MAINE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 CENTER ST
AUBURN ME
04210-6323
US

IV. Provider business mailing address

593 CENTER ST
AUBURN ME
04210-6323
US

V. Phone/Fax

Practice location:
  • Phone: 207-782-2004
  • Fax: 207-782-2005
Mailing address:
  • Phone: 207-782-2004
  • Fax: 207-782-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number38361
License Number StateME

VIII. Authorized Official

Name: SUSAN MORIN
Title or Position: REGIONAL MANAGER
Credential:
Phone: 207-795-5646