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1230 Maine St Room A Poland ME 04274-7325 | |
(207) 998-4483 | |
(207) 998-2189 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1230 Maine St, Poland, Maine |
Authorized Official Name and Position | Coleen L Elias (CEO/CFO) |
Authorized Official Contact | 2075133897 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 95000 Lbx 7660 Philadelphia PA 19195-0001 Ph: (207) 777-8208 | 1230 Maine St Room A Poland ME 04274-7325 Ph: (207) 998-4483 |
NPI Number | 1417301623 |
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Provider Enumeration Date | 04/14/2016 |
Last Update Date | 10/22/2020 |
Medicare PECOS PAC ID | 0042101099 |
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Medicare Enrollment ID | O20160810002390 |
Identifier | Type | State | Issuer |
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1417301623 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |