MEDICARE: MAINE SCHOOL OF SCIENCE AND MATHEMATICS

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	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1609426691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINE SCHOOL OF SCIENCE AND MATHEMATICS

Provider Business Mailing Address
First Line	:	95 HIGH ST
Second Line	:
City	:	LIMESTONE
State	:	ME
Zip	:	04750-1141
Country	:	US
Telephone Number	:	207-325-3798
Fax Number	:	207-325-3614

Provider Business Practice Location Address
First Line	:	77 HIGH ST
Second Line	:
City	:	LIMESTONE
State	:	ME
Zip	:	04750-1141
Country	:	US
Telephone Number	:	207-325-3798
Fax Number	:	207-325-3614

Authorized Official
Title or Position	:	MEDICAL DIRECTOR FOR MSSM
Name	:	JAYMIE ST. PETER
Credential	:	FNP
Telephone Number	:	207-227-0123

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	09/12/2019

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