Provider Demographics
NPI:1376829598
Name:MAINE MOBILE HEALTH PROGRAM, INC.
Entity Type:Organization
Organization Name:MAINE MOBILE HEALTH PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-622-9252
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0405
Mailing Address - Country:US
Mailing Address - Phone:207-622-9252
Mailing Address - Fax:207-626-7612
Practice Address - Street 1:9 GREEN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7451
Practice Address - Country:US
Practice Address - Phone:207-622-9252
Practice Address - Fax:207-626-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)