Provider Demographics
NPI:1265554604
Name:WARDWELL POINT WHOLE HEALTH
Entity type:Organization
Organization Name:WARDWELL POINT WHOLE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-497-2996
Mailing Address - Street 1:541 MASON BAY RD
Mailing Address - Street 2:
Mailing Address - City:JONESPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04649-3501
Mailing Address - Country:US
Mailing Address - Phone:207-497-2996
Mailing Address - Fax:207-497-3467
Practice Address - Street 1:RR 1 BOX 56
Practice Address - Street 2:WARDWELL POINT RD.
Practice Address - City:PENOBSCOT
Practice Address - State:ME
Practice Address - Zip Code:04476-9705
Practice Address - Country:US
Practice Address - Phone:207-497-2996
Practice Address - Fax:207-497-3467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE48086OtherHARVARD PILGRIM
ME189960000Medicaid
MEE004797OtherTRICARE
ME3342110OtherAETNA
MEDA3087OtherRAILROAD MEDICARE
ME046639OtherBCBS
ME4254797OtherAETNA
MEME0132Medicare PIN