Provider Demographics
NPI:1164660783
Name:JOHN F. GADDIS
Entity Type:Organization
Organization Name:JOHN F. GADDIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-255-3338
Mailing Address - Street 1:P.O. BOX 189
Mailing Address - Street 2:FACTORY ROAD
Mailing Address - City:EAST MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04630-0189
Mailing Address - Country:US
Mailing Address - Phone:207-255-3338
Mailing Address - Fax:207-255-0534
Practice Address - Street 1:FACTORY ROAD
Practice Address - Street 2:
Practice Address - City:EAST MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04630-0189
Practice Address - Country:US
Practice Address - Phone:207-255-3338
Practice Address - Fax:307-355-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
ME1034261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty