Healthcare Provider Details

I. General information

NPI: 1043640204
Provider Name (Legal Business Name): BLUEWATER EMERGENCY PARTNERS OF BRUNSWICK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MAINE ST STE 306
BRUNSWICK ME
04011-2049
US

IV. Provider business mailing address

PO BOX 417479
BOSTON MA
02241-7479
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-9065
  • Fax: 207-560-9904
Mailing address:
  • Phone: 866-959-6774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES MULLEN
Title or Position: PRESIDENT
Credential: MD
Phone: 207-725-9065