Healthcare Provider Details

I. General information

NPI: 1851942429
Provider Name (Legal Business Name): NORTHERN MAINE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 E MAIN ST
FORT KENT ME
04743-1428
US

IV. Provider business mailing address

194 E MAIN ST
FORT KENT ME
04743-1428
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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