Healthcare Provider Details

I. General information

NPI: 1568465144
Provider Name (Legal Business Name): NORTHERN MAINE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 EAST MAIN STREET
FORT KENT ME
04743-1428
US

IV. Provider business mailing address

194 EAST MAIN STREET
FORT KENT ME
04743-1428
US

V. Phone/Fax

Practice location:
  • Phone: 207-834-3155
  • Fax: 207-834-2949
Mailing address:
  • Phone: 207-834-3155
  • Fax: 207-834-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number36151
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number36943
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number37310
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY ZEWE
Title or Position: CEO
Credential:
Phone: 207-834-1411