=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265441323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTERN MAINE HEALTHCARE SYSTEMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2006
-----------------------------------------------------
Last Update Date | 07/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 364 PRITHAM AVE
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-695-5220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 364 PRITHAM AVE
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARIE VIENNEAU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-695-5271
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 36400
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------