| |
474 Main St Springvale ME 04083-1409 | |
(207) 490-6900 | |
(207) 324-0546 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 474 Main St, Springvale, Maine |
Authorized Official Name and Position | Diane Laurendeau (CFO) |
Authorized Official Contact | 2073245762 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6 Spruce St Sanford ME 04073-2917 Ph: (207) 324-5762 | 474 Main St Springvale ME 04083-1409 Ph: (207) 490-6900 |
NPI Number | 1932578259 |
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Provider Enumeration Date | 09/16/2015 |
Last Update Date | 01/19/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932578259 | NPI | - | NPPES |
000216073 | Medicaid | ME |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |