MEDICARE: NORTHERN MAINE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP0814X	Psychoanalysis Psychologist
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1053345546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN MAINE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	194 E MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1428
Country	:	US
Telephone Number	:	207-834-1850
Fax Number	:	207-834-2522

Provider Business Practice Location Address
First Line	:	194 E MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1428
Country	:	US
Telephone Number	:	207-834-3101
Fax Number	:	207-834-2917

Authorized Official
Title or Position	:	CEO
Name	:	JEFFREY ZEWE
Credential	:
Telephone Number	:	207-834-1411

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	04/08/2024

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