Provider Demographics
NPI:1790886802
Name:JONESPORT-BEALS FAMILY CLINIC
Entity Type:Organization
Organization Name:JONESPORT-BEALS FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASSAAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-255-6831
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0317
Mailing Address - Country:US
Mailing Address - Phone:207-255-6831
Mailing Address - Fax:207-255-6832
Practice Address - Street 1:298 MAIN ST
Practice Address - Street 2:
Practice Address - City:JONESPORT
Practice Address - State:ME
Practice Address - Zip Code:04649-3345
Practice Address - Country:US
Practice Address - Phone:207-255-6831
Practice Address - Fax:207-255-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9366Medicare ID - Type Unspecified