Healthcare Provider Details

I. General information

NPI: 1518293547
Provider Name (Legal Business Name): SEBASTICOOK FAMILY DOCTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MAIN ST
CANAAN ME
04924-3407
US

IV. Provider business mailing address

118 MOOSEHEAD TRL SUITE 5
NEWPORT ME
04953-4055
US

V. Phone/Fax

Practice location:
  • Phone: 207-474-6990
  • Fax: 207-474-8899
Mailing address:
  • Phone: 207-368-4213
  • Fax: 207-355-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBIN WINSLOW
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 207-368-4213