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General NPI Number Information
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NPI Number | 1952482804
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Entity Type | Organization
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Legal Business Name | DFD RUSSELL MEDICAL CENTER INC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 180 CHURCH HILL RD SUITE 1
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City | LEEDS
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State | ME
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Zip | 04263-3418
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Country | US
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Telephone | 207-524-3501
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Fax | 207-524-2459
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Provider Business Mailing Address
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Address Line | 180 CHURCH HILL RD SUITE 1
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City | LEEDS
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State | ME
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Zip | 04263-3418
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Country | US
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Telephone | 207-524-3501
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Fax | 207-524-2459
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Authorized Official
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Title or Position | CEO
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Name | LAURIE A KANE-LEWIS
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Credential |
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Telephone | 207-524-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | ME
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