Basic Information
| Provider Information | |||||||||
| NPI: | 1750836656 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN MAINE HEALTH CARE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SMHC SANFORD WALK IN CARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072837000 | ||||||||
| FaxNumber: | 2072837063 | ||||||||
| Practice Location | |||||||||
| Address1: | 25A JUNE ST | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040732642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072837000 | ||||||||
| FaxNumber: | 2072837063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2016 | ||||||||
| LastUpdateDate: | 08/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | BELAIR | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 2072837898 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 38427 | ME | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.