Provider Demographics
NPI:1417079039
Name:MRH CORP.
Entity Type:Organization
Organization Name:MRH CORP.
Other - Org Name:NORTHERN LIGHT PRIMARY CARE DEXTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIENNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-564-4251
Mailing Address - Street 1:51 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:ME
Mailing Address - Zip Code:04930-1311
Mailing Address - Country:US
Mailing Address - Phone:207-924-7349
Mailing Address - Fax:207-564-1285
Practice Address - Street 1:51 HIGH ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1311
Practice Address - Country:US
Practice Address - Phone:207-924-7349
Practice Address - Fax:207-924-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDB7803OtherRAILROAD MEDICARE
ME203835OtherRHC NUMBER