Healthcare Provider Details

I. General information

NPI: 1235393430
Provider Name (Legal Business Name): WESTERN MAINE OSTEOPATHIC HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MAIN ST
FARMINGTON ME
04938-1910
US

IV. Provider business mailing address

225 MAIN ST
FARMINGTON ME
04938-1910
US

V. Phone/Fax

Practice location:
  • Phone: 207-778-6999
  • Fax: 207-778-6980
Mailing address:
  • Phone: 207-778-6999
  • Fax: 207-778-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1746
License Number StateME

VIII. Authorized Official

Name: CHRISTIE A JAMES
Title or Position: PRESIDENT
Credential: D.O.
Phone: 207-778-6999