Healthcare Provider Details

I. General information

NPI: 1922087246
Provider Name (Legal Business Name): NORTHERN MAINE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 04/08/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MAIN ST
MADAWASKA ME
04756-1088
US

IV. Provider business mailing address

194 E MAIN ST
FORT KENT ME
04743-1428
US

V. Phone/Fax

Practice location:
  • Phone: 207-728-7300
  • Fax:
Mailing address:
  • Phone: 207-834-1411
  • Fax: 207-834-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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