Healthcare Provider Details

I. General information

NPI: 1285551598
Provider Name (Legal Business Name): CONVENIENTMD - FFS UC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WATERVILLE COMMONS DR UNIT 1B
WATERVILLE ME
04901-4900
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 207-352-2025
  • Fax: 207-352-2680
Mailing address:
  • Phone: 603-410-6700
  • Fax: 603-309-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RACHEL CASTELLEZ-DAVIDSON
Title or Position: MEDICAL STAFFING LEAD
Credential:
Phone: 603-867-1291