Provider Demographics
NPI:1164561478
Name:WESTERN MAINE MULTI-MEDICAL SPECIALISTS
Entity Type:Organization
Organization Name:WESTERN MAINE MULTI-MEDICAL SPECIALISTS
Other - Org Name:WESTERN MAINE MOUNTAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT FISCAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-743-5933
Mailing Address - Street 1:181 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5664
Mailing Address - Country:US
Mailing Address - Phone:207-743-1562
Mailing Address - Fax:207-743-1566
Practice Address - Street 1:23 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEWRY
Practice Address - State:ME
Practice Address - Zip Code:04261-3229
Practice Address - Country:US
Practice Address - Phone:207-824-4900
Practice Address - Fax:207-824-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM6575Medicare ID - Type UnspecifiedPROVIDER ID NUMBER