Provider Demographics
NPI:1255484655
Name:LONG PLAINS MEDICAL
Entity Type:Organization
Organization Name:LONG PLAINS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-929-5155
Mailing Address - Street 1:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-0018
Mailing Address - Country:US
Mailing Address - Phone:207-929-5155
Mailing Address - Fax:207-929-5156
Practice Address - Street 1:27 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6530
Practice Address - Country:US
Practice Address - Phone:207-929-5155
Practice Address - Fax:207-929-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty