Provider Demographics
NPI:1093002438
Name:RIVERTREE OSTEOPATHIC HEALTH PC
Entity Type:Organization
Organization Name:RIVERTREE OSTEOPATHIC HEALTH PC
Other - Org Name:FREEPORT OSTEOPATHIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-865-6655
Mailing Address - Street 1:460 AUGUSTA RD APT B
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-5728
Mailing Address - Country:US
Mailing Address - Phone:207-865-6655
Mailing Address - Fax:207-865-6653
Practice Address - Street 1:460 AUGUSTA RD APT B
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-5728
Practice Address - Country:US
Practice Address - Phone:207-865-6655
Practice Address - Fax:207-865-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1766204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty