Provider Demographics
NPI:1154988707
Name:MAINE URGENT CARE, LLC
Entity type:Organization
Organization Name:MAINE URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING & CREDENTIALING SPECIAL
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-789-6661
Mailing Address - Street 1:101 S PHILLIPS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6719
Mailing Address - Country:US
Mailing Address - Phone:605-789-6661
Mailing Address - Fax:417-429-2893
Practice Address - Street 1:685 SABATTUS STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-0000
Practice Address - Country:US
Practice Address - Phone:207-795-5050
Practice Address - Fax:207-795-5049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINE URGENT CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care