Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 55 Reynolds Road, Brooks, Maine |
Authorized Official Name and Position | Lugene Anthony Inzana (ASSOCIATE CFO, MAINEHEALTH) |
Authorized Official Contact | 2076622654 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 159 Brooks ME 04921-0159 Ph: (207) 722-3488 | 55 Reynolds Road Brooks ME 04921 Ph: (207) 722-3488 |
NPI Number | 1487720215 |
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Provider Enumeration Date | 11/24/2006 |
Last Update Date | 10/13/2024 |
Medicare PECOS PAC ID | 7517860588 |
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Medicare Enrollment ID | O20181105001616 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487720215 | NPI | - | NPPES |
101570201 | Medicaid | ME |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 36424 (* (Not Available)) | Primary |