Provider Demographics
NPI:1063464634
Name:SEBASTICOOK FAMILY DOCTORS
Entity Type:Organization
Organization Name:SEBASTICOOK FAMILY DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-368-4213
Mailing Address - Street 1:118 MOOSEHEAD TRL
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4020
Mailing Address - Country:US
Mailing Address - Phone:207-368-4213
Mailing Address - Fax:207-355-3033
Practice Address - Street 1:118 MOOSEHEAD TRL
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4020
Practice Address - Country:US
Practice Address - Phone:207-368-4213
Practice Address - Fax:207-355-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9313OtherMEDICARE B GROUP NUMBER
ME201842Medicare Oscar/Certification