Provider Demographics
NPI:1548785371
Name:NORTHERN MAINE MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTHERN MAINE MEDICAL CENTER
Other - Org Name:NORTHERN MAINE MEDICAL CENTER LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-834-1411
Mailing Address - Street 1:104 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1437
Mailing Address - Country:US
Mailing Address - Phone:207-728-7200
Mailing Address - Fax:207-728-7227
Practice Address - Street 1:104 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756
Practice Address - Country:US
Practice Address - Phone:207-728-7200
Practice Address - Fax:207-728-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH500016683336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431916600Medicaid