Healthcare Provider Details

I. General information

NPI: 1124113345
Provider Name (Legal Business Name): SUNBURY PRIMARY CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 CORPORATE DRIVE SUITE 2
BANGOR ME
04401
US

IV. Provider business mailing address

PO BOX 921
BANGOR ME
04402-0921
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-9286
  • Fax: 207-992-9287
Mailing address:
  • Phone: 207-990-0864
  • Fax: 207-990-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID L SAVELL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 207-942-7650