Provider Demographics
NPI:1831186972
Name:FAMILY HEALTHCARE ASSOCIATES PA
Entity type:Organization
Organization Name:FAMILY HEALTHCARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCTS/BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMBERLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-783-0591
Mailing Address - Street 1:190 STETSON RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-7813
Mailing Address - Country:US
Mailing Address - Phone:207-783-0591
Mailing Address - Fax:207-795-2043
Practice Address - Street 1:190 STETSON RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-7813
Practice Address - Country:US
Practice Address - Phone:207-783-0591
Practice Address - Fax:207-795-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========OtherGROUP BILLING NUMBER
MEMM3416Medicare ID - Type UnspecifiedGROUP BILLING NUMBER