Provider Demographics
NPI:1962588913
Name:SOUTHERN MAINE INTEGRATIVE HEALTH CENTER, LLC
Entity type:Organization
Organization Name:SOUTHERN MAINE INTEGRATIVE HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MULCAHY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-985-3079
Mailing Address - Street 1:69 YORK ST STE 4
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7186
Mailing Address - Country:US
Mailing Address - Phone:207-985-3079
Mailing Address - Fax:
Practice Address - Street 1:69 YORK ST
Practice Address - Street 2:SUITE 4
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7153
Practice Address - Country:US
Practice Address - Phone:207-985-3079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME2352OtherMEDICARE
MEH34794Medicare UPIN