Provider Demographics
NPI:1396026803
Name:SEBASTICOOK FAMILY DOCTORS
Entity Type:Organization
Organization Name:SEBASTICOOK FAMILY DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-368-5189
Mailing Address - Street 1:118 MOOSEHEAD TRL
Mailing Address - Street 2:STE 5
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4055
Mailing Address - Country:US
Mailing Address - Phone:207-355-3505
Mailing Address - Fax:207-474-8899
Practice Address - Street 1:453 MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-5310
Practice Address - Country:US
Practice Address - Phone:207-355-3505
Practice Address - Fax:207-474-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty