Provider Demographics
NPI:1790982809
Name:MAINEGENERAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:MAINEGENERAL HEALTH ASSOCIATES
Other - Org Name:EVERGREEN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-626-1063
Mailing Address - Street 1:150 DRESDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2615
Mailing Address - Country:US
Mailing Address - Phone:207-621-9337
Mailing Address - Fax:207-621-3609
Practice Address - Street 1:246 KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4556
Practice Address - Country:US
Practice Address - Phone:207-873-6655
Practice Address - Fax:207-877-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME164570013Medicaid
ME164570013Medicaid