Provider Demographics
NPI:1427403245
Name:KENNEBUNK WALK-IN CLINIC
Entity Type:Organization
Organization Name:KENNEBUNK WALK-IN CLINIC
Other - Org Name:FAMILY PRACTICE ON THE RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-502-7386
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046-1100
Mailing Address - Country:US
Mailing Address - Phone:207-502-7386
Mailing Address - Fax:207-502-7661
Practice Address - Street 1:62 PORTLAND RD STE 47
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6650
Practice Address - Country:US
Practice Address - Phone:207-502-7386
Practice Address - Fax:207-502-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD14675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty