NPIMap

Organization Active NPI

Northern Maine Medical Center

Doing business as St John Valley Pharmacy

  • Community/Retail Pharmacy
  • Fort Kent, ME
National Provider Identifier
1952303422
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH50001216 Issued in ME
Legal business name
NORTHERN MAINE MEDICAL CENTER
Doing business as
St John Valley Pharmacy
Practice address
182 Market St
Ste 2
Fort Kent, ME 04743
Phone
(207) 834-2880
Fax
(207) 834-2882
NPI assigned
Aug 13, 2005
Last updated
Mar 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Aaron Teachout
Title
Cfo
Phone
(207) 834-1820

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PH50001216 ME Primary

Addresses

Primary practice location

182 Market St
Ste 2
Fort Kent, ME 04743

Mailing address

PO Box 189
Fort Kent, ME 04743
Phone (207) 834-2880

Other identifiers 2

IdentifierTypeStateIssuer
424260000MedicaidME
2037573OtherPK

Other names 1

  • ST JOHN VALLEY PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20110201000283 ME Part B Supplier - Mass Immunization (Roster Biller Only) 5294945382 Practice locations: Fort Kent, ME
O20180813001505 ME Part B Supplier - Mass Immunization (Roster Biller Only) 8426952987 Practice locations: Fort Kent, ME
O20250805002632 ME Part B Supplier - Pharmacy 3375455207 Practice locations: Fort Kent, ME
O20250926002422 ME DME Supplier - Pharmacy 3375455207 Practice locations: Fort Kent, ME

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Forest Hill Manor12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

104 E Main St
Fort Kent, ME 04743
Phone (207) 834-3101

182 Market St
Fort Kent, ME 04743
Phone (207) 834-2880

182 Market St
#2
Fort Kent, ME 04743
Phone (207) 834-2880

82 W Main St
Fort Kent, ME 04743
Phone (207) 834-2762

460 Main St
Madawaska, ME 04756
Phone (207) 728-7300

Practitioners & affiliated clinicians

Practitioners 137

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 137

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1952303422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "FORT KENT",
            "state": "ME",
            "postal_code": "04743",
            "telephone_number": "207-834-2880",
            "fax_number": "207-834-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 MARKET ST",
            "address_2": "STE 2",
            "city": "FORT KENT",
            "state": "ME",
            "postal_code": "04743",
            "telephone_number": "207-834-2880",
            "fax_number": "207-834-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MAINE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-13",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "TEACHOUT",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "207-834-1820"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ME",
            "license": "PH50001216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "424260000",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2037573",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST JOHN VALLEY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Kent, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.