Provider Demographics
NPI:1942453683
Name:MAINEGENERAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:MAINEGENERAL HEALTH ASSOCIATES
Other - Org Name:KENNEBEC FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, MGHA
Authorized Official - Prefix:
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:207-626-1097
Mailing Address - Street 1:13 RAILROAD SQ
Mailing Address - Street 2:KENNEBEC FAMILY PRACTICE
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6139
Mailing Address - Country:US
Mailing Address - Phone:207-872-6869
Mailing Address - Fax:207-872-7910
Practice Address - Street 1:13 RAILROAD SQ
Practice Address - Street 2:KENNEBEC FAMILY PRACTICE
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6139
Practice Address - Country:US
Practice Address - Phone:207-872-6869
Practice Address - Fax:207-872-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM3808Medicare PIN