Healthcare Provider Details

I. General information

NPI: 1386147098
Provider Name (Legal Business Name): NORTHERN MAINE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MAIN ST
MADAWASKA ME
04756-1437
US

IV. Provider business mailing address

104 MAIN ST
MADAWASKA ME
04756-1437
US

V. Phone/Fax

Practice location:
  • Phone: 207-728-7200
  • Fax: 207-728-7227
Mailing address:
  • Phone: 207-728-7200
  • Fax: 207-728-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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