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General NPI Number Information
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NPI Number | 1194850297
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Entity Type | Organization
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Legal Business Name | WESTERN MAINE MULTI-MEDICAL SPECIALIST
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 23 S RIDGE RD
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City | NEWRY
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State | ME
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Zip | 04261-3229
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Country | US
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Telephone | 207-824-4910
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Fax | 207-824-4910
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Provider Business Mailing Address
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Address Line | 181 MAIN ST
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City | NORWAY
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State | ME
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Zip | 04268-5664
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Country | US
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Telephone | 207-743-1562
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Fax | 207-743-3940
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Authorized Official
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Title or Position | CONTROLLER
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Name | MRS. DIANA J MCLAUGHLIN
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Credential |
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Telephone | 207-743-1562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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