Provider Demographics
NPI:1578777819
Name:THOMAS R. MAYCOCK
Entity Type:Organization
Organization Name:THOMAS R. MAYCOCK
Other - Org Name:WALDO COUNTY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:MAYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-338-1120
Mailing Address - Street 1:9 FAHEY ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6028
Mailing Address - Country:US
Mailing Address - Phone:207-338-1120
Mailing Address - Fax:207-338-1691
Practice Address - Street 1:9 FAHEY ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6028
Practice Address - Country:US
Practice Address - Phone:207-338-1120
Practice Address - Fax:207-338-1691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME080086258OtherRR MEDICARE
ME314800099Medicaid
ME118460000Medicaid
ME012002OtherANTHEM BC BS
MEE000363OtherCHAMPUS
ME314800099Medicaid
MEE000363OtherCHAMPUS
MEB86870Medicare UPIN
MEM6491Medicare ID - Type UnspecifiedGROUP