| |
409 Roosevelt Trl Windham ME 04062-4821 | |
(207) 400-8618 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 409 Roosevelt Trl, Windham, Maine |
Authorized Official Name and Position | David Patrick Kennedy (VP FINANCE) |
Authorized Official Contact | 2078793363 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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175 Fore River Pkwy Portland ME 04102-2779 Ph: () - | 409 Roosevelt Trl Windham ME 04062-4821 Ph: (207) 400-8618 |
NPI Number | 1396496378 |
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Provider Enumeration Date | 01/12/2022 |
Last Update Date | 04/12/2024 |
Medicare PECOS PAC ID | 6103737812 |
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Medicare Enrollment ID | O20220617001130 |
Identifier | Type | State | Issuer |
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1396496378 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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