=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871312322
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATIVE MEDICINE OF MAINE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2024
-----------------------------------------------------
Last Update Date | 11/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 871 COURT ST
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04210-3903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-376-4983
-----------------------------------------------------
Fax | 207-376-4983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 273 LOWER ST
-----------------------------------------------------
City | TURNER
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04282-3903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-212-9698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | DR. ANNE BROWN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 207-212-9698
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------