Provider Demographics
NPI:1699967224
Name:RUMFORD COMMUNITY FAMILY HEALTH CENTER INC.
Entity type:Organization
Organization Name:RUMFORD COMMUNITY FAMILY HEALTH CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIVISION CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-369-0146
Mailing Address - Street 1:431 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2100
Mailing Address - Country:US
Mailing Address - Phone:207-364-7831
Mailing Address - Fax:307-369-9467
Practice Address - Street 1:431 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2100
Practice Address - Country:US
Practice Address - Phone:207-364-7831
Practice Address - Fax:307-369-9467
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUMFORD COMMUNITY FAMILY HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-17
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME125700100Medicaid
ME125700100Medicaid