| |
4 Clement Way Belgrade ME 04917-4370 | |
(207) 495-3323 | |
(207) 495-3353 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 4 Clement Way, Belgrade, Maine |
Authorized Official Name and Position | Constance R Coggins (PRESIDENT/CEO) |
Authorized Official Contact | 2078725610 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
4 Clement Way Belgrade ME 04917-4370 Ph: (207) 495-3323 | 4 Clement Way Belgrade ME 04917-4370 Ph: (207) 495-3323 |
NPI Number | 1851364632 |
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Provider Enumeration Date | 02/10/2006 |
Last Update Date | 11/10/2014 |
Medicare PECOS PAC ID | 5496726523 |
---|---|
Medicare Enrollment ID | O20050830000523 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851364632 | NPI | - | NPPES |
137970109 | Medicaid | ME | |
CA2004 | Other | ME | MEDICARE ID TYPE UNSPECIFIED |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | E58728 (Maine) | Primary |
Provider Name | Patrice M Thibodeau |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1902992308 PECOS PAC ID: 5799724399 Enrollment ID: I20050503000004 |
Provider Name | Rita Alfonso Labarbera |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1508195520 PECOS PAC ID: 0941245500 Enrollment ID: I20050623000610 |
Provider Name | Amy K Madden |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508975152 PECOS PAC ID: 5496813164 Enrollment ID: I20081024000076 |
Provider Name | Deborah Daigle |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1154341139 PECOS PAC ID: 2769527787 Enrollment ID: I20100302000624 |
Provider Name | Roy Miller |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1700854361 PECOS PAC ID: 9032306212 Enrollment ID: I20101214000796 |
Provider Name | Diane Zavotsky |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1023128261 PECOS PAC ID: 8123099215 Enrollment ID: I20141104001286 |
Provider Name | Hannah Lasell Whipple |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225155567 PECOS PAC ID: 8628176682 Enrollment ID: I20160224002490 |
Provider Name | Angela Kristoff |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1124570833 PECOS PAC ID: 3375825706 Enrollment ID: I20170120000081 |
Provider Name | Tabitha Sagner |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1003243163 PECOS PAC ID: 4284909672 Enrollment ID: I20171011001968 |
Provider Name | Stacey Lea Anderson |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1710990775 PECOS PAC ID: 5294627204 Enrollment ID: I20180725002775 |
Provider Name | Denise M Thorn |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1518484898 PECOS PAC ID: 5294086484 Enrollment ID: I20180927001380 |
Provider Name | Heather L Reed |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1649498882 PECOS PAC ID: 0941462055 Enrollment ID: I20200317001309 |
Provider Name | Brittany Ann Bennett |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083227664 PECOS PAC ID: 4183034507 Enrollment ID: I20201112003329 |
Provider Name | Kelly Leslie |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447896147 PECOS PAC ID: 8729494950 Enrollment ID: I20210311002951 |
Provider Name | Katie Gillihan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750945986 PECOS PAC ID: 4789084369 Enrollment ID: I20210618001147 |
Provider Name | Kathleen A Roberts |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053307090 PECOS PAC ID: 4082627781 Enrollment ID: I20210826003594 |
Provider Name | Theresa A Rush |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336739267 PECOS PAC ID: 3870999352 Enrollment ID: I20210908003545 |
Provider Name | Michelle R Breen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538732607 PECOS PAC ID: 3971909359 Enrollment ID: I20210909003793 |
Provider Name | Andrew Curtis Alexander |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225793847 PECOS PAC ID: 1153711031 Enrollment ID: I20211208001976 |
Provider Name | Andrew Twaite |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770234809 PECOS PAC ID: 5294129953 Enrollment ID: I20220223002830 |
Provider Name | Abigail L Dalzell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538892740 PECOS PAC ID: 9133505159 Enrollment ID: I20220928003278 |
Provider Name | Jenna Martini |
---|---|
Provider Type | Practitioner - Osteopathic Manipulative Medicine |
Provider Identifiers | NPI Number: 1710390711 PECOS PAC ID: 7517224496 Enrollment ID: I20221108000656 |
Provider Name | Monica Gambi Lado |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255065165 PECOS PAC ID: 0648649194 Enrollment ID: I20221206001417 |
Provider Name | Cinder Savage |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1043863640 PECOS PAC ID: 1052784451 Enrollment ID: I20230306002345 |
Provider Name | Melanie Ann Morin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1558803130 PECOS PAC ID: 3870966187 Enrollment ID: I20230308000761 |
Provider Name | Debora B Ivy Sanderson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427044288 PECOS PAC ID: 5193736775 Enrollment ID: I20230320000115 |
Provider Name | Kelly Ann Cohen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1154973725 PECOS PAC ID: 3072912690 Enrollment ID: I20230405000233 |
Provider Name | Daniel J Keane |
---|---|
Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1982608410 PECOS PAC ID: 8022180066 Enrollment ID: I20230905001677 |
Provider Name | Amy Elizabeth Peters |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285314757 PECOS PAC ID: 6901250166 Enrollment ID: I20230922000295 |
Provider Name | Kaylee Shae Puanani Wolfe |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285364489 PECOS PAC ID: 1456727437 Enrollment ID: I20231002002911 |
Provider Name | Marc Melnick |
---|---|
Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1851305924 PECOS PAC ID: 3870882764 Enrollment ID: I20231204001416 |
Provider Name | Kristina Mont |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1053721274 PECOS PAC ID: 1557719101 Enrollment ID: I20240122002384 |
Provider Name | Lauren Emery |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1376997817 PECOS PAC ID: 3476901034 Enrollment ID: I20240123002392 |
Provider Name | Amanda Adamen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477321156 PECOS PAC ID: 8022455526 Enrollment ID: I20240320000486 |
Provider Name | Rebecca Ann Disarro |
---|---|
Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1396586053 PECOS PAC ID: 5193261436 Enrollment ID: I20240723004236 |
Provider Name | Abigail Cross |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1710568761 PECOS PAC ID: 4385182658 Enrollment ID: I20240817000110 |