Provider Demographics
NPI:1699187690
Name:RAYMOND REDICARE PC
Entity Type:Organization
Organization Name:RAYMOND REDICARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-655-6181
Mailing Address - Street 1:1278 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-6604
Mailing Address - Country:US
Mailing Address - Phone:207-655-6181
Mailing Address - Fax:
Practice Address - Street 1:1278 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:ME
Practice Address - Zip Code:04071-6604
Practice Address - Country:US
Practice Address - Phone:207-655-6181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA342261Q00000X
MEDO2302261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center