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General NPI Number Information
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NPI Number | 1205150323
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Entity Type | Organization
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Legal Business Name | WESTERN MAINE MULTI-MEDICAL SPECIALISTS
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 34 WINTER ST
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City | NORWAY
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State | ME
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Zip | 04268-5620
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Country | US
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Telephone | 207-743-8031
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Fax | 207-743-6672
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Provider Business Mailing Address
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Address Line | 301 US ROUTE 1 BUILDING C
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City | SCARBOROUGH
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State | ME
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Zip | 04074-7609
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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Authorized Official
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Title or Position | SR VP FISCAL
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Name | JOHN COX
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Credential |
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Telephone | 207-743-9292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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