Provider Demographics
NPI:1851661516
Name:MAX HEALTH MAINE LLC
Entity Type:Organization
Organization Name:MAX HEALTH MAINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-699-0901
Mailing Address - Street 1:PO BOX 6233
Mailing Address - Street 2:MAX HEALTH MAINE LLC
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-0033
Mailing Address - Country:US
Mailing Address - Phone:207-699-0901
Mailing Address - Fax:207-699-0902
Practice Address - Street 1:1226 SHORE RD
Practice Address - Street 2:MAX HEALTH MAINE LLC
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2123
Practice Address - Country:US
Practice Address - Phone:207-699-0901
Practice Address - Fax:207-699-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013535261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care