MEDICARE: WARDWELL POINT WHOLE HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	013248	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	DA3087	OTHER	ME	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E48086	OTHER	ME	HARVARD PILGRIM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	E004797	OTHER	ME	TRICARE
4	3342110	OTHER	ME	AETNA
6	046639	OTHER	ME	BCBS
7	4254797	OTHER	ME	AETNA

General Provider Information

NPI Number	:	1265554604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARDWELL POINT WHOLE HEALTH

Provider Business Mailing Address
First Line	:	541 MASON BAY RD
Second Line	:
City	:	JONESPORT
State	:	ME
Zip	:	04649-3501
Country	:	US
Telephone Number	:	207-497-2996
Fax Number	:	207-497-3467

Provider Business Practice Location Address
First Line	:	RR 1 BOX 56
Second Line	:	WARDWELL POINT RD.
City	:	PENOBSCOT
State	:	ME
Zip	:	04476-9705
Country	:	US
Telephone Number	:	207-497-2996
Fax Number	:	207-497-3467

Authorized Official
Title or Position	:	OWNER
Name	:	JERRI JENSEN
Credential	:	MD
Telephone Number	:	207-497-2996

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	06/27/2008

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Directions to “WARDWELL POINT WHOLE HEALTH ” Practice Location

Language	Start Address	Practice Location

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