Provider Demographics
NPI:1386946804
Name:LEWISTON PRIMARY CARE CLINIC
Entity type:Organization
Organization Name:LEWISTON PRIMARY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:ABDIHAKIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:ABDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-344-9899
Mailing Address - Street 1:PO BOX 7972
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7972
Mailing Address - Country:US
Mailing Address - Phone:207-344-9899
Mailing Address - Fax:
Practice Address - Street 1:280 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7304
Practice Address - Country:US
Practice Address - Phone:207-344-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-04
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization