Healthcare Provider Details

I. General information

NPI: 1154988707
Provider Name (Legal Business Name): MAINE URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 SABATTUS STREET
LEWISTON ME
04240-0000
US

IV. Provider business mailing address

101 S PHILLIPS AVE STE 300
SIOUX FALLS SD
57104-6719
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-5050
  • Fax: 207-795-5049
Mailing address:
  • Phone: 605-789-6661
  • Fax: 417-429-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIMBERLY J FROCK
Title or Position: CONTRACTING & CREDENTIALING SPECIAL
Credential:
Phone: 605-789-6661