Provider Demographics
NPI:1639203458
Name:LYMPHORMATION CENTER
Entity Type:Organization
Organization Name:LYMPHORMATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-786-6989
Mailing Address - Street 1:675 MAIN ST
Mailing Address - Street 2:MARKETPLACE MALL THE COMMONS
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5802
Mailing Address - Country:US
Mailing Address - Phone:207-786-6989
Mailing Address - Fax:207-786-6990
Practice Address - Street 1:675 MAIN ST
Practice Address - Street 2:MARKETPLACE MALL THE COMMONS
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5802
Practice Address - Country:US
Practice Address - Phone:207-786-6989
Practice Address - Fax:207-786-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1547174400000X
MEPT2735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty