Provider Demographics
NPI:1578599775
Name:RUMFORD COMMUNITY FAMILY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:RUMFORD COMMUNITY FAMILY HEALTH CENTER, INC.
Other - Org Name:SWIFT RIVER FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-369-0146
Mailing Address - Street 1:430 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2104
Mailing Address - Country:US
Mailing Address - Phone:207-369-0146
Mailing Address - Fax:207-364-8626
Practice Address - Street 1:430 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2104
Practice Address - Country:US
Practice Address - Phone:207-369-0146
Practice Address - Fax:207-364-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME203989261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000209013OtherPRIMECARE NUMBER
ME125700100Medicaid
ME203989Medicare ID - Type UnspecifiedRHC NUMBER
ME125700100Medicaid