Provider Demographics
NPI:1891975900
Name:UNION RIVER MEDICINE. LLC
Entity type:Organization
Organization Name:UNION RIVER MEDICINE. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:CHALRES
Authorized Official - Last Name:DENNY-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-667-5955
Mailing Address - Street 1:405 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3901
Mailing Address - Country:US
Mailing Address - Phone:207-667-5955
Mailing Address - Fax:207-667-7002
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3901
Practice Address - Country:US
Practice Address - Phone:207-667-5955
Practice Address - Fax:207-667-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME7846302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9878Medicare PIN