Provider Demographics
NPI:1700975794
Name:FREEPORT MEDICAL CENTER PA
Entity Type:Organization
Organization Name:FREEPORT MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:KNIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-865-3491
Mailing Address - Street 1:23 DURHAM RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6796
Mailing Address - Country:US
Mailing Address - Phone:207-865-3491
Mailing Address - Fax:207-865-4351
Practice Address - Street 1:23 DURHAM RD STE 201
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6796
Practice Address - Country:US
Practice Address - Phone:207-865-3491
Practice Address - Fax:207-865-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1648261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service