MEDICARE: MAX HEALTH MAINE LLC

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	261QP2300X	Primary Care Clinic/Center	013535	ME

General Provider Information

NPI Number	:	1851661516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAX HEALTH MAINE LLC

Provider Business Mailing Address
First Line	:	PO BOX 6233
Second Line	:	MAX HEALTH MAINE LLC
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-0033
Country	:	US
Telephone Number	:	207-699-0901
Fax Number	:	207-699-0902

Provider Business Practice Location Address
First Line	:	1226 SHORE RD
Second Line	:	MAX HEALTH MAINE LLC
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-2123
Country	:	US
Telephone Number	:	207-699-0901
Fax Number	:	207-699-0902

Authorized Official
Title or Position	:	PHYSICIAN SOLE PROPRIETOR
Name	:	DR. TERRY ANN SCRIVEN
Credential	:	MD
Telephone Number	:	207-699-0901

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	04/30/2013

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Directions to “MAX HEALTH MAINE LLC ” Practice Location

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