Provider Demographics
NPI:1548382328
Name:MRH CORP.
Entity Type:Organization
Organization Name:MRH CORP.
Other - Org Name:NORTHERN LIGHT PRIMARY CARE DOVER-FOXCROFT
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 1:897 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-564-4464
Mailing Address - Fax:207-564-4461
Practice Address - Street 1:891 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1059
Practice Address - Country:US
Practice Address - Phone:207-564-4464
Practice Address - Fax:207-564-4461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MRH CORP.
Parent Organization TIN:<UNAVAIL>
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
MEC22673OtherRAILROAD MEDICARE
MEDC3866OtherRAILROAD MEDICARE
ME203993Medicare Oscar/Certification