Provider Demographics
NPI:1275845604
Name:INLAND FAMILY PRACTICE ASSOCIATES,LLC
Entity Type:Organization
Organization Name:INLAND FAMILY PRACTICE ASSOCIATES,LLC
Other - Org Name:THE CLINIC AT WALMART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BITHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-861-3000
Mailing Address - Street 1:222 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4526
Mailing Address - Country:US
Mailing Address - Phone:800-395-0232
Mailing Address - Fax:207-873-2385
Practice Address - Street 1:80 WATERVILLE COMMONS DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4900
Practice Address - Country:US
Practice Address - Phone:207-680-2110
Practice Address - Fax:207-680-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service