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NPI Code Detail

MEDICARE: DFD RUSSELL MEDICAL CENTER INC

MEDICARE: DFD RUSSELL MEDICAL CENTER INC
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
1261QF0400XFederally Qualified Health Center (FQHC)ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528377454
Entity Type Code : Organization
Provider Name (Legal Business Name) : DFD RUSSELL MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 180 CHURCH HILL RD
Second Line : STE 1
City : LEEDS
State : ME
Zip : 04263-3418
Country : US
Telephone Number : 207-524-3501
Fax Number : 207-524-2459
Provider Business Practice Location Address
First Line : 11 ACADEMY RD
Second Line :
City : MONMOUTH
State : ME
Zip : 04259-7035
Country : US
Telephone Number : 207-933-9646
Fax Number : 207-933-9645
Authorized Official
Title or Position : CEO
Name : LAURIE A KANE-LEWIS
Credential :
Telephone Number : 207-524-3501
Provider Enumeration Date : 09/27/2010
Last Update Date : 02/09/2024

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Directions to “DFD RUSSELL MEDICAL CENTER INC ” Practice Location

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