Provider Demographics
NPI:1558431460
Name:BERWICK FAMILY HEALTH CENTER LLC
Entity Type:Organization
Organization Name:BERWICK FAMILY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:LIBENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-698-7900
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-0719
Mailing Address - Country:US
Mailing Address - Phone:207-698-7900
Mailing Address - Fax:207-698-7977
Practice Address - Street 1:6C SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03901
Practice Address - Country:US
Practice Address - Phone:207-698-7900
Practice Address - Fax:207-698-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30202194Medicaid
ME174580000Medicaid
ME043568OtherANTHEM
NH30202194Medicaid