Healthcare Provider Details

I. General information

NPI: 1578599775
Provider Name (Legal Business Name): RUMFORD COMMUNITY FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 FRANKLIN ST
RUMFORD ME
04276-2104
US

IV. Provider business mailing address

430 FRANKLIN ST
RUMFORD ME
04276-2104
US

V. Phone/Fax

Practice location:
  • Phone: 207-369-0146
  • Fax: 207-364-8626
Mailing address:
  • Phone: 207-369-0146
  • Fax: 207-364-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number203989
License Number StateME

VIII. Authorized Official

Name: DR. JOHN KROGER
Title or Position: DIVISION CHIEF
Credential: MD
Phone: 207-369-0146