Provider Demographics
NPI:1194850297
Name:WESTERN MAINE MULTI-MEDICAL SPECIALIST
Entity Type:Organization
Organization Name:WESTERN MAINE MULTI-MEDICAL SPECIALIST
Other - Org Name:WESTERN MAINE MOUNTAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-743-1562
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:207-743-3940
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:207-824-4910
Practice Address - Fax:207-824-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center