Provider Demographics
NPI:1750563888
Name:WEBBER HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:WEBBER HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP MEDICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVOIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-283-7898
Mailing Address - Street 1:39 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6143
Mailing Address - Country:US
Mailing Address - Phone:207-283-7000
Mailing Address - Fax:207-283-7070
Practice Address - Street 1:72 MAIN ST
Practice Address - Street 2:PARK SQUARE
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7021
Practice Address - Country:US
Practice Address - Phone:207-467-8909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432732804Medicaid
ME101580000Medicaid
ME101580000Medicaid
MEDE4478Medicare PIN
ME200019Medicare Oscar/Certification