Healthcare Provider Details

I. General information

NPI: 1255690228
Provider Name (Legal Business Name): SOUTHERN MAINE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN ST
SACO ME
04072-1543
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-294-5600
  • Fax:
Mailing address:
  • Phone: 207-283-7000
  • Fax: 207-283-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number37567
License Number StateME

VIII. Authorized Official

Name: NORMAN BELAIR
Title or Position: SENIOR VP OF FINANCE/CFO
Credential:
Phone: 207-283-7898