Provider Demographics
NPI:1487842019
Name:BREWER HEALTH CENTER PA
Entity Type:Organization
Organization Name:BREWER HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-989-5588
Mailing Address - Street 1:401 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2322
Mailing Address - Country:US
Mailing Address - Phone:207-989-5588
Mailing Address - Fax:207-989-1599
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2322
Practice Address - Country:US
Practice Address - Phone:207-989-5588
Practice Address - Fax:207-989-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1127261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1639130099OtherNPI
MED93053Medicare UPIN