Provider Demographics
NPI:1134295769
Name:YORK PRIMARY CARE LLC
Entity Type:Organization
Organization Name:YORK PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-361-4902
Mailing Address - Street 1:1 BRICKYARD LN
Mailing Address - Street 2:SUITE CC
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1604
Mailing Address - Country:US
Mailing Address - Phone:207-361-4902
Mailing Address - Fax:207-363-2505
Practice Address - Street 1:1 BRICKYARD LN
Practice Address - Street 2:SUITE CC
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1604
Practice Address - Country:US
Practice Address - Phone:207-361-4902
Practice Address - Fax:207-363-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431948300Medicaid
ME431948300Medicaid
MEME1544Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER