NPIMap

Organization Active NPI

Northern Maine Medical Center

  • Rural Health Clinic/Center
  • Fort Kent, ME
National Provider Identifier
1962481077
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NORTHERN MAINE MEDICAL CENTER
Practice address
194 E Main St
Fort Kent, ME 04743
Phone
(207) 834-6140
NPI assigned
Jan 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Authorized official

Name
Mr. Jeffrey Zewe
Title
Ceo
Phone
(207) 834-1411

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

194 E Main St
Fort Kent, ME 04743

Mailing address

194 E Main St
Fort Kent, ME 04743
Phone (207) 834-5877

Other identifiers 1

IdentifierTypeStateIssuer
165800100MedicaidME

Other names 1

  • Fort Kent Family Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071128000225 ME Part A Provider - Rural Health Clinic 3375455207 Practice locations: Fort Kent, ME

Rural health clinic certification: CCN 208503

Legal name
NORTHERN MAINE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2003
Last certification
May 15, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 5, 1940 in ME
Enrollment address
194 E Main St
Fort Kent, ME 04743-1428
Related CCNs
200052

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
No Maine Medical Ctr12 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

194 E Main St
Ste 1
Fort Kent, ME 04743

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gisele Dionne Individual Corporate DirectorBoard Member Jan 30, 2019
Lucie Tabor Individual Corporate DirectorBoard Member Jan 15, 2021
Daniel Vaillancourt Individual Corporate DirectorBoard Member Jan 1, 2020
John Ezzy Individual Corporate DirectorBoard Member Jan 1, 2022
Steven Ouellette Individual Corporate DirectorBoard Member Jan 15, 2021
Jeffrey Zewe Individual Corporate OfficerCeo May 1, 2022
W-2 Managing EmployeeCeo May 1, 2022
Aaron Teachout Individual Corporate OfficerCfo Sep 30, 2021
W-2 Managing EmployeeCfo Sep 30, 2021
Norman L Fournier Individual Corporate DirectorBoard Member Jan 18, 2011
Donald Guimond Individual Corporate DirectorBoard Member Jul 21, 2015
Erin Soucy Individual Corporate DirectorBoard Member Jun 28, 2016
Douglas Cyr Individual Corporate DirectorBoard Member Jan 1, 2020
Alain Bois Individual Corporate OfficerCoo Mar 29, 2021
W-2 Managing EmployeeCoo Mar 29, 2021
James V Harris Individual Corporate DirectorBoard Member Jun 20, 2023
Steven Pelletier Individual Corporate DirectorBoard Member Jan 1, 2018

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1962481077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 E MAIN ST",
            "city": "FORT KENT",
            "state": "ME",
            "postal_code": "04743",
            "telephone_number": "207-834-5877",
            "fax_number": "207-834-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 E MAIN ST",
            "city": "FORT KENT",
            "state": "ME",
            "postal_code": "04743",
            "telephone_number": "207-834-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MAINE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-17",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "ZEWE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-834-1411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165800100",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Kent Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Kent, ME

Sources for this page

Verify at the official NPI Registry.