Provider Demographics
NPI:1295757888
Name:OSTEOPATHIC FAMILYCARE, LLC
Entity type:Organization
Organization Name:OSTEOPATHIC FAMILYCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSETT-WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-869-9119
Mailing Address - Street 1:43 TODD BROOK RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6253
Mailing Address - Country:US
Mailing Address - Phone:207-869-9119
Mailing Address - Fax:207-869-9117
Practice Address - Street 1:43 TODD BROOK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6253
Practice Address - Country:US
Practice Address - Phone:207-869-9119
Practice Address - Fax:207-869-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME124750000Medicaid
MEI65431Medicare UPIN
MEME2203Medicare PIN