Provider Demographics
NPI:1043224330
Name:MID-MAINE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:MID-MAINE INTERNAL MEDICINE
Other - Org Name:BURKE,SMITH & PRESTON, MD,PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-873-6173
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:N VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04962-0247
Mailing Address - Country:US
Mailing Address - Phone:207-873-6173
Mailing Address - Fax:207-873-4514
Practice Address - Street 1:905 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTH VASSALBORO
Practice Address - State:ME
Practice Address - Zip Code:04962
Practice Address - Country:US
Practice Address - Phone:207-873-6173
Practice Address - Fax:207-873-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C20487OtherRAILROAD MEDICARE
=========OtherTAX ID
MM2292Medicare ID - Type Unspecified