Healthcare Provider Details

I. General information

NPI: 1689743080
Provider Name (Legal Business Name): SUNBURY PRIMARY CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 2 MAIN RD
CARMEL ME
04419
US

IV. Provider business mailing address

PO BOX 921
BANGOR ME
04402-0921
US

V. Phone/Fax

Practice location:
  • Phone: 207-848-7501
  • Fax: 207-848-5970
Mailing address:
  • Phone: 207-990-0864
  • Fax: 207-990-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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