Provider Demographics
NPI:1497475701
Name:UCFA PHYSICIANS NETWORK GROUP OF MAINE
Entity Type:Organization
Organization Name:UCFA PHYSICIANS NETWORK GROUP OF MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:THEO
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-271-9911
Mailing Address - Street 1:8930 CROSS PARK DR STE 3
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4713
Mailing Address - Country:US
Mailing Address - Phone:423-271-9911
Mailing Address - Fax:
Practice Address - Street 1:6 CITY CTR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4000
Practice Address - Country:US
Practice Address - Phone:423-271-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty