Healthcare Provider Details

I. General information

NPI: 1275845604
Provider Name (Legal Business Name): INLAND FAMILY PRACTICE ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WATERVILLE COMMONS DR
WATERVILLE ME
04901-4900
US

IV. Provider business mailing address

222 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4526
US

V. Phone/Fax

Practice location:
  • Phone: 207-680-2110
  • Fax: 207-680-2114
Mailing address:
  • Phone: 800-395-0232
  • Fax: 207-873-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DEAN BITHER
Title or Position: V.P. FINANCE
Credential:
Phone: 207-861-3000