Provider Demographics
NPI:1609426691
Name:MAINE SCHOOL OF SCIENCE AND MATHEMATICS
Entity Type:Organization
Organization Name:MAINE SCHOOL OF SCIENCE AND MATHEMATICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR FOR MSSM
Authorized Official - Prefix:
Authorized Official - First Name:JAYMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. PETER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:207-227-0123
Mailing Address - Street 1:95 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:ME
Mailing Address - Zip Code:04750-1141
Mailing Address - Country:US
Mailing Address - Phone:207-325-3798
Mailing Address - Fax:207-325-3614
Practice Address - Street 1:77 HIGH ST
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:ME
Practice Address - Zip Code:04750-1141
Practice Address - Country:US
Practice Address - Phone:207-325-3798
Practice Address - Fax:207-325-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health