Healthcare Provider Details

I. General information

NPI: 1699975078
Provider Name (Legal Business Name): OSTEOPATHIC CENTER FOR FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MAIN RD N
HAMPDEN ME
04444-1804
US

IV. Provider business mailing address

603 MAIN RD N
HAMPDEN ME
04444-1804
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-5400
  • Fax: 866-463-6751
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME1760
License Number StateME

VIII. Authorized Official

Name: LEIGH FORBUSH
Title or Position: MEMBER
Credential: DO
Phone: 207-945-5400