Healthcare Provider Details

I. General information

NPI: 1467666230
Provider Name (Legal Business Name): UNIVERSITY OF MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 CUTLER HEALTH CENTER
ORONO ME
04469
US

IV. Provider business mailing address

PO BOX 1810
WINDHAM ME
04062
US

V. Phone/Fax

Practice location:
  • Phone: 207-281-3997
  • Fax:
Mailing address:
  • Phone: 207-892-0020
  • Fax: 207-893-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0710
License Number StateME

VIII. Authorized Official

Name: RICHARD C YOUNG
Title or Position: AUXILIARY DIRECTOR
Credential:
Phone: 207-581-4184