| Organization Name: | DFD RUSSELL MEDICAL CENTER INC |
| NPI Number: | 1528377454 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURIE A KANE-LEWIS (CEO) |
| Mailing Address: | 11 Academy Rd Monmouth |
| State: | ME US |
| Postal Code: | 042597035 |
| Phone Number: | 2079339646 |
| Fax Number: | 2079339645 |
| NPI Enumeration Date: | 09/27/2010 |
| NPI Last Update Date: | 06/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |