Healthcare Provider Details

I. General information

NPI: 1609426691
Provider Name (Legal Business Name): MAINE SCHOOL OF SCIENCE AND MATHEMATICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HIGH ST
LIMESTONE ME
04750-1141
US

IV. Provider business mailing address

95 HIGH ST
LIMESTONE ME
04750-1141
US

V. Phone/Fax

Practice location:
  • Phone: 207-325-3798
  • Fax: 207-325-3614
Mailing address:
  • Phone: 207-325-3798
  • Fax: 207-325-3614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAYMIE ST. PETER
Title or Position: MEDICAL DIRECTOR FOR MSSM
Credential: FNP
Phone: 207-227-0123