1184645921 NPI number — NORTHERN MAINE MEDICAL CENTER

Table of content: (NPI 1184645921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184645921 NPI number — NORTHERN MAINE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN MAINE MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184645921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
194 EAST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT KENT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-834-3155
Provider Business Mailing Address Fax Number:
207-834-2949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 MARKET STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
FORT KENT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-834-2881
Provider Business Practice Location Address Fax Number:
207-834-2082
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOIS
Authorized Official First Name:
ALAIN
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
207-834-3155

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1184645921 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2037589 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com