Healthcare Provider Details

I. General information

NPI: 1265961148
Provider Name (Legal Business Name): FULL CIRCLE AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 CEDAR LN
NOBLEBORO ME
04555-8664
US

IV. Provider business mailing address

PO BOX 484
DAMARISCOTTA ME
04543-0484
US

V. Phone/Fax

Practice location:
  • Phone: 888-873-8817
  • Fax: 888-919-7737
Mailing address:
  • Phone: 888-873-8817
  • Fax: 888-919-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME12495
License Number StateME

VIII. Authorized Official

Name: DR. ALLAN STURGES TEEL
Title or Position: PRESIDENT
Credential: MD
Phone: 888-873-8817