Healthcare Provider Details

I. General information

NPI: 1891975900
Provider Name (Legal Business Name): UNION RIVER MEDICINE. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MAIN ST
ELLSWORTH ME
04605-3901
US

IV. Provider business mailing address

405 MAIN ST
ELLSWORTH ME
04605-3901
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-5955
  • Fax: 207-667-7002
Mailing address:
  • Phone: 207-667-5955
  • Fax: 207-667-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number7846
License Number StateME

VIII. Authorized Official

Name: MR. BRUCE CHALRES DENNY-BROWN
Title or Position: OWNER
Credential: MD
Phone: 207-667-5955