Healthcare Provider Details

I. General information

NPI: 1285487330
Provider Name (Legal Business Name): NORTHERN MAINE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
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: 207-728-6359
  • Fax:
Mailing address:
  • Phone: 207-834-1850
  • Fax: 207-834-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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