Healthcare Provider Details

I. General information

NPI: 1487179669
Provider Name (Legal Business Name): BOOTHBAY REGION HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 07/12/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 TOWNSEND AVE STE R
BOOTHBAY HARBOR ME
04538-1895
US

IV. Provider business mailing address

185 TOWNSEND AVE STE R
BOOTHBAY HARBOR ME
04538-1895
US

V. Phone/Fax

Practice location:
  • Phone: 207-633-1075
  • Fax: 207-633-1067
Mailing address:
  • Phone: 207-633-1075
  • Fax: 877-492-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA SEYBOLD
Title or Position: DIRECTOR
Credential:
Phone: 207-633-4368