Provider Demographics
NPI:1720153851
Name:WISCASSET HEALTH CENTER
Entity Type:Organization
Organization Name:WISCASSET HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-882-7512
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:136 GARDINER RD
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-0387
Mailing Address - Country:US
Mailing Address - Phone:207-882-7512
Mailing Address - Fax:207-882-7513
Practice Address - Street 1:136 GARDINER RD
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-0387
Practice Address - Country:US
Practice Address - Phone:207-882-7512
Practice Address - Fax:207-882-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME007890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5167014001OtherCIGNA
ME1042534OtherAETNA
ME1042534OtherAETNA
ME5167014001OtherCIGNA