Northern Maine Medical Center
Organization Active NPI Rural Health Clinic/Center · Madawaska, ME
NPI 1922087246 · NPPES record last updated Apr 8, 2024
Key facts
- NPI
- 1922087246
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- NORTHERN MAINE MEDICAL CENTER
- Practice address
- 460 Main St
Madawaska, ME 04756-1088 - Phone
- (207) 728-7300
- NPI assigned
- Jan 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeffrey Zewe
- Title
- Ceo
- Phone
- (207) 834-1411
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 11
Member of 1
Practitioners 13
-
Steven Albert, FNP
-
Inez Joan Butler, APRN
-
Melissa Crchova, M.D.
-
Jennifer Karyl Daigle, AGNP-C
-
Lisa M. Eno, FNP
-
Debbra A McGlaughlin, FNP
-
Sonya Poiesz, FNP
-
Beril Bayrak, M.D.
-
Andrea Gault, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
Rural health clinic certification: CCN 208502
- Legal name
- NORTHERN MAINE MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 1, 2003
- Last certification
- Jun 15, 2021
- Ownership / control type
- 2A
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 5, 1940 in ME
- Enrollment address
- 460 Main St
Ste 201
Madawaska, ME 04756-1088 - Related CCNs
- 200052
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Gisele Dionne |
Corporate Director |
Jan 30, 2019 | |
| Lucie Tabor |
Corporate Director |
Jan 15, 2021 | |
| Daniel Vaillancourt |
Corporate Director |
Jan 1, 2020 | |
| John Ezzy |
Corporate Director |
Jan 1, 2022 | |
| Steven Ouellette |
Corporate Director |
Jan 15, 2021 | |
| Jeffrey Zewe |
Corporate Officer |
May 1, 2022 | |
| W-2 Managing Employee |
May 1, 2022 | ||
| Aaron Teachout |
Corporate Officer |
Sep 30, 2021 | |
| W-2 Managing Employee |
Sep 30, 2021 | ||
| Norman L Fournier |
Corporate Director |
Jan 18, 2011 | |
| Donald Guimond |
Corporate Director |
Jul 21, 2015 | |
| Erin Soucy |
Corporate Director |
Jun 28, 2016 | |
| Douglas Cyr |
Corporate Director |
Jan 1, 2020 | |
| Alain Bois |
Corporate Officer |
Mar 29, 2021 | |
| W-2 Managing Employee |
Mar 29, 2021 | ||
| James V Harris |
Corporate Director |
Jun 20, 2023 | |
| Steven Pelletier |
Corporate Director |
Jan 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130904000398 | ME | Part a Provider - Rural Health Clinic | 3375455207 | Practice locations: Madawaska, ME |
National Provider Directory
- Tax ID family
- No Maine Medical Ctr
Locations
460 Main St
Ste 104A
Madawaska, ME 04756
460 Main St
Ste 201
Madawaska, ME 04756
Phone (207) 728-7300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
460 Main St
Madawaska, ME 04756-1088
Mailing address
194 E Main St
Fort Kent, ME 04743-1428
Phone (207) 834-1411
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 165800104 | Medicaid | ME |
Other names
- Acadia Family Health Center
Other providers in Madawaska, ME
- Jason Nadeau
- Northern Maine Medical Center
- Northern Maine Medical Center
- Northern Maine Medical Center
- Northern Maine Medical Center
- Tina Ouellette
- Kayla Parks
- Patrick E Pauwels
- Jasmine Pelletier
- Shawn D Pelletier
All providers in Madawaska, ME · Rural Health Clinic/Center in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.