Healthcare Provider Details

I. General information

NPI: 1750836656
Provider Name (Legal Business Name): SOUTHERN MAINE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25A JUNE ST
SANFORD ME
04073-2642
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-7000
  • Fax: 207-283-7063
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 Number38427
License Number StateME

VIII. Authorized Official

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