Provider Demographics
NPI:1336503515
Name:EAST BANK HEALTH
Entity Type:Organization
Organization Name:EAST BANK HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:207-200-1907
Mailing Address - Street 1:369 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2351
Mailing Address - Country:US
Mailing Address - Phone:207-200-1907
Mailing Address - Fax:207-989-0970
Practice Address - Street 1:369 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2351
Practice Address - Country:US
Practice Address - Phone:207-200-1907
Practice Address - Fax:207-989-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1170 DO204D00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty