Provider Demographics
NPI:1417116112
Name:SUNBURY PRIMARY CARE PA
Entity Type:Organization
Organization Name:SUNBURY PRIMARY CARE PA
Other - Org Name:DIRIGO OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-942-7650
Mailing Address - Street 1:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0921
Mailing Address - Country:US
Mailing Address - Phone:207-942-7650
Mailing Address - Fax:207-990-5583
Practice Address - Street 1:9 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3479
Practice Address - Country:US
Practice Address - Phone:207-223-5674
Practice Address - Fax:207-223-5675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNBURY PRIMARY CARE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty