Healthcare Provider Details

I. General information

NPI: 1114774254
Provider Name (Legal Business Name): SEBASTICOOK FAMILY DOCTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FLETCHER DR
PALMYRA ME
04965
US

IV. Provider business mailing address

55 FLETCHER DR
PALMYRA ME
04965
US

V. Phone/Fax

Practice location:
  • Phone: 207-368-5189
  • Fax: 207-368-4213
Mailing address:
  • Phone: 207-368-5189
  • Fax: 207-368-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
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