Provider Demographics
NPI:1568780823
Name:SEBASTICOOK VALLEY FAMILY PRACTICE ASSOCIATION
Entity Type:Organization
Organization Name:SEBASTICOOK VALLEY FAMILY PRACTICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-487-4022
Mailing Address - Street 1:447 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-3707
Mailing Address - Country:US
Mailing Address - Phone:207-487-4021
Mailing Address - Fax:207-487-4021
Practice Address - Street 1:1573 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:ME
Practice Address - Zip Code:04965-3236
Practice Address - Country:US
Practice Address - Phone:207-487-4021
Practice Address - Fax:207-487-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center