Provider Demographics
NPI:1750443842
Name:NORTHERN MAINE MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTHERN MAINE MEDICAL CENTER
Other - Org Name:NMMC MEDICAL OFFICE BUILDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 1:194 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1428
Mailing Address - Country:US
Mailing Address - Phone:207-834-5877
Mailing Address - Fax:207-834-2522
Practice Address - Street 1:197 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1409
Practice Address - Country:US
Practice Address - Phone:207-834-6784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME208513Medicare Oscar/Certification