Provider Demographics
NPI:1356356869
Name:THE MEDICAL GROUP DEPARTMENT OF GOODALL HOSPITAL
Entity type:Organization
Organization Name:THE MEDICAL GROUP DEPARTMENT OF GOODALL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WEBER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-490-7861
Mailing Address - Street 1:7 SHAPE DR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6601
Mailing Address - Country:US
Mailing Address - Phone:207-985-7174
Mailing Address - Fax:207-985-1304
Practice Address - Street 1:7 SHAPE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6601
Practice Address - Country:US
Practice Address - Phone:207-985-7174
Practice Address - Fax:207-985-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty