Provider Demographics
NPI:1407041619
Name:PROVIDERS CARE PA
Entity Type:Organization
Organization Name:PROVIDERS CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-286-2273
Mailing Address - Street 1:27 LOCHLANNACH LN
Mailing Address - Street 2:
Mailing Address - City:ARUNDEL
Mailing Address - State:ME
Mailing Address - Zip Code:04046-8974
Mailing Address - Country:US
Mailing Address - Phone:207-286-2273
Mailing Address - Fax:207-282-6118
Practice Address - Street 1:28 W COLE RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9428
Practice Address - Country:US
Practice Address - Phone:207-286-2273
Practice Address - Fax:207-282-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431575300Medicaid
ME431575300Medicaid