Provider Demographics
NPI:1184645921
Name:NORTHERN MAINE MEDICAL CENTER
Entity type:Organization
Organization Name:NORTHERN MAINE MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-834-3155
Mailing Address - Street 1:194 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743
Mailing Address - Country:US
Mailing Address - Phone:207-834-3155
Mailing Address - Fax:207-834-2949
Practice Address - Street 1:182 MARKET STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743
Practice Address - Country:US
Practice Address - Phone:207-834-2881
Practice Address - Fax:207-834-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1184645921Medicaid
2037589OtherPK
2037589OtherPK